Trodelvy and new drugs reached an agreement with the NHIS

Trodelvy's innovativeness was acknowledged, and its price was measured by incremental cost-effectiveness ratio (ICER) thresholds

Will be reviewed by the Health Insurance Policy Deliberation Committee at the end of this month and will likely be reimbursed in June

Product photo of Trodelvy

Three new drugs, including the triple-negative breast cancer (TNBC) treatment Trodelvy (sacituzumab govitecan), have completed negotiations with the National Health Insurance Service (NHIS) and are about to be included in the reimbursement list.

 

These drugs passed the Health Insurance Review and Assessment Service (HIRA)'s Drug Reimbursement Evaluation Committee (DREC) in February and were undergoing negotiations with the NHIS.

 

According to industry sources on May 15, the NHIS posted on its website that the companies of the TNBC drug 'Trodelvy,' the pulmonary hypertension drug 'Adempas Tab (riociguat, Bayer Korea),' and the plaque psoriasis drug 'Bimzelx Autoinjector (bimekizumab, UCB Korea)' have agreed on negotiation deals.

 

During the 2nd DREC meeting on February 6, these drugs were acknowledged for their reimbursement appropriateness.

 

The DREC granted reimbursement appropriateness for Trodevly's TNBC indication and Adempas' pulmonary hypertension among its efficacy·effectiveness.

 

The efficacy·effectiveness of Adempas in chronic thromboembolic pulmonary hypertension (CTEPH) was not acknowledged for reimbursement appropriateness.

 

For Bimzelx, the company received a decision that Bimzelx would meet the appropriateness of reimbursement if the company accepted an amount below the standard.

 

After that, UCB accepted the condition and proceeded to negotiations with the NHIS.

 

The company may have undergone negotiations with the NHIS for drug pricing and estimated claim amount, ultimately reaching an agreement.

 

Among these drugs, Trodelvy received a decision of new drug innovativeness.

 

It gained attention for becoming the first case to clear the DREC review, with its price being measured based on their ICER values.

 

The Korea Alliance of Patients Organization (hereafter, Patients Organization) is asking for a quick reimbursement process since Trodelvy is the third-line treatment for adult patients with unresectable locally advanced or metastatic triple-negative breast cancer (mTNBC).

 

The Patients Organization said, "Trodelvy is a high-cost drug, costing approximately KRW 1,500-2,000 per one cycle and some hundreds of millions of KRW yearly." They added, "Patients cannot continue treatment due to high-cost non-reimbursed drug costs and inevitably give up on receiving treatments." As these companies reached drug pricing negotiations with the NHIS, the drugs will be reviewed by the Health Insurance Policy Deliberation Committee.

 

The drugs have higher chances of being included in the reimbursement list next month (June).