Reimb imminent for switching between atopic dermatitis drugs

The agenda enters negotiation stage with the NHIS

HIRA completes review through a preliminary drug price reduction system

Negotiations are likely to progress easily due to the low expected claims amount

Switching between atopic dermatitis drugs may be reimbursed soon.

 

This is because the National Health Insurance Service has completed its review through the preliminary drug price reduction system, and all that remains is the National Health Insurance Service's negotiations.

 

As the expected claim amount is not large, the negotiations are expected to be completed without difficulty.

 

According to industry sources on the 3rd, the Health Insurance Review & Assessment Service (HIRA) has completed its review on expanding reimbursement to cross-administration between biological drugs and JAK inhibitors through the preliminary drug price reduction system and reported it to the Ministry of Health and Welfare.

 

The review was completed after the Drug Reimbursement Evaluation Committee, which was held on January 9, recognized the appropriateness of the reimbursement benefits and collected opinions from pharmaceutical companies.

 

Relevant pharmaceutical companies have not submitted separate objections on the agenda.

 

In the case of expanding the scope of use, if the expected additional claim is less than KRW 1.5 billion, the drug price reduction will not be applied, and if it is between KRW 1.5 billion and 10 billion, a preliminary price reduction will be applied, and if it is over KRW 10 billion, drug price negotiations will be conducted.

 

This cross-administration between biological drugs and JAK inhibitors was subject to a preliminary drug price reduction, and the drug price reduction rate for individual products was determined according to the formula.

 

The target items include biologics such as Dupixent (dupilumab) and Adtralza (tralokinumab), and JAK inhibitors such as Rinvoq (upadacitinib), Olumiant (baricitinib), and Cibinqo (abrocitinib).

 

If approved, most patients will be switching from biological drugs to JAK inhibitors, which will likely lead to an increase in the amount of claims for JAK inhibitors.

 

However, the amount of additional claims is not expected to be high.

 

Accordingly, industry insiders believe that the drug price reduction rate may well be determined based on the formula without drug price negotiations, Even if the NHIS enters drug price negotiations, the industry believes that it will be easy to reach an agreement as the level of the expected additional claims amount will be low.

 

It is analyzed that cross-administration may be reimbursable from March at the earliest after being reported to the Health Insurance Review and Assessment Service.

 

Meanwhile, the current reimbursement standard requires that patients with severe atopic dermatitis who have used biological agents or JAK inhibitors to have first administered the first-line treatment for 3 months and meet the criteria of Eczema Area and Severity Index (EASI) 23 or higher to switch to other drugs.

 

The regulations made it difficult to immediately replace the drug even if side effects occur or the treatment is ineffective, so healthcare professionals have urged the government to reimburse cross-administration without conditions.

 

Health authorities have been considering expanding reimbursement of cross-administration between biological agents and JAK inhibitors since last year.