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- 2026-03-10 02:17:05
- Opinion
- [Reporter's View] Restricting vs expanding access
- by Eo, Yun-Ho Dec 05, 2024 05:53am
- The addition of a post-listing control system seems to be a fixed deal. The establishment of the Drug Performance Evaluation Office under the Health Insurance Review and Assessment Policy Research Institute has already taken place, and government officials have been publicly discussing using RWD (Real-world data) for drugs subject to the exemption from submission of pharmacoeconomic evaluation data. So the key to its implementation will be in the contents of the ‘dialogue.’ Will the system act as another mechanism to lower drug prices and cause much friction, or will it be a reasonable 'uncertainty resolution' device per government claims? Is the PE exemption system necessary? Its need is one question both the government and industry see eye to eye on. Only some academics and civil society organizations are opposed to its need in itself. In Korea's insurance policy environment, the pharmacoeconomic evaluation exemption system is the only way to ensure that the treatments needed by patients with rare diseases and rare cancers are listed for insurance reimbursement. Based on the evaluation results in major HTA countries (UK, Australia, Canada, Germany, and France) of the 37 drugs that have been approved through the PE exemption system, foreign countries either recognize single-arm clinical studies as indirect comparisons or regard the clinical needs of patients and healthcare providers, innovation, and urgency of treatment, to promptly approve drugs even if its cost-effectiveness is somewhat uncertain under the Korean criteria. If the uncertainty about the long-term effectiveness and cost-effectiveness of these new drugs had to be reviewed within the pharmacoeconomic evaluation system, they would have been reimbursed later than other countries or would have remained non-reimbursed. It is true that there is much to discuss, such as the methodology for implementing RWD and who should bear the expense. But as the agenda is already on the plate, it is clear that something has to be done. If so, to address the growing concerns over the rise in PE exemption drugs, a measure needs to be set in place to address the diminishing benefits. The time has come to revitalize the indirect comparisons that the industry has been advocating for so long, compensate for the lower prices of substitutes that have been lowered by years of post-listing control measures, and at least consider a flexible approach to the ICER thresholds. In the same context, the amendments to the ‘Detailed Evaluation Criteria for Drugs subject to Negotiations, including New Drugs,’ which was announced in August need to be finalized and implemented quickly to ensure the provision of benefits. Both sides, those who want to restrict and those who want to extend reimbursement, cannot be satisfied at once. The key is compromise. The fact that more taxes are spent on people with serious illnesses is no excuse to neglect them.
- Opinion
- [Reporter's View] what 'AI-driven drug discovery' requires
- by Kim, Jin-Gu Nov 26, 2024 05:54am
- This year’s Nobel Prize in Chemistry was jointly awarded to David Baker, a professor at the University of Washington, Demis Hassabis, CEO of Google DeepMind, and John Jumper, Director at DeepMind. Professor Baker was recognized for his contribution to creating protein design models. The DeepMind team was honored for developing 'AlphaFold,' which reduced the time required for protein structure prediction from years to mere hours using AI. The potential of AI in drug development has once again been recognized following the winning of the Nobel Prize. At the same time, it has alleviated concerns that AI-driven drug discovery is just chasing a mirage. In South Korea, various AI-driven drug discovery projects are being conducted. The chief project is the 'K-MELLODDY (Machine Learning Ledger Orchestration for Drug Discovery)' project. It is a Korean version of the MELLODDY project, in which 10 global pharmaceutical companies such as Amgen, key European universities, and biotech startups participated in 2020. The core of this project is federated learning. This method gathers data from individual pharmaceutical companies and research institutions to train AI models. To maintain data privacy, it encrypts gathered data. The goal is to shorten the lengthy drug development process significantly. In South Korea, eight pharmaceutical companies, including Daewoong Pharmaceutical·Dong Wha Pharm·Samjin Pharmaceutical·Yuhan Corporation·Jeil Pharmaceutical·Hanmi Pharmaceutical·Huons·JW Pharmaceutical, are participating. The project includes five universities and hospitals, such as Seoul National University Hospital, and four research institutes, including the Korea Research Institute of Bioscience and Biotechnology (KRIBB). AI drug development companies Simplex and Aifase are also part of the project. Experts in AI-driven drug development unanimously emphasize the importance of 'high-quality data' for AI training. A large volume of data is not sufficient. They explain that pharmaceutical companies or research institutions must utilize detailed clinical and preclinical data to accelerate drug discovery. The challenge lies in gathering clinical and preclinical data from individual pharmaceutical companies into one. These data are the intellectual property of each company and the culmination of extensive efforts by numerous research and development teams. While federated learning employs heavily encrypted processes to protect this data, companies remain hesitant and concerned about the potential external leakage of their core proprietary information. The same applies to clinical failure data. Experts stress that failure data is just as important as success data for AI training. Some explain that failure data is more effective in teaching AI systems. However, from the perspective of pharmaceutical companies, systematically recording and managing clinical failure data is a cumbersome task. The pharmaceutical companies participating in the K-MELLODDY project likely have overcome these concerns and challenges to unite around meeting the goal of AI-driven drug development. They deserve recognition. However, it is crucial to encourage more companies to participate. Only then can Korean pharmaceutical companies compete with global pharmaceutical companies that train AI systems on larger datasets worldwide. The government's involvement is crucial to encouraging more Korean companies to participate. The Ministry of Health and Welfare (MOHW) and the Ministry of Science and ICT (MSIT) have agreed to support KRW 34.8 billion in the K-MELLODDY project by 2028. Some argue that while the budget is significant, it may be insufficient to attract greater participation from pharmaceutical companies. In addition to establishing the federated learning platform, direct support for participating companies is essential. The current vision, which promises to reduce the considerable time and costs of drug development alone, is insufficient to give incentive. The government must take a more proactive role so that the goal of creating effective AI models for drug discovery can be closer.
- Opinion
- [Desk's View] Re-evaluation of eye drops
- by Lee, Tak-Sun Nov 22, 2024 05:55am
- The government has established reimbursement criteria for single-use ophthalmic solutions, including hyaluronic acid eye drops for conditions like dry eye syndrome. A year has passed after the primary result of the re-evaluation regarding the reimbursement appropriateness for hyaluronic acid eye drops were released in September 2023. When the primary result was released, no one anticipated establishing reimbursement criteria would take this long. The pharmaceutical companies had accepted the primary results without filing objections. At the time, the Drug Reimbursement Evaluation Committee (DREC), responsible for evaluating the reimbursement appropriateness, approved the appropriateness of reimbursement for hyaluronic acid eye drops in treating intrinsic conditions such as Sjögren's syndrome, keratoconjunctivitis sicca, and dry eye syndrome. However, DREC determined that there was no reimbursement appropriateness for extrinsic conditions, including post-surgical use, drug-induced dryness, trauma, or contact lens-related issues. Furthermore, the DREC stated that usage restrictions for intrinsic conditions should be included in the reimbursement criteria. Because prescriptions for intrinsic conditions account for 80% of the total, pharmaceutical companies accepted the results of the primary result. However, the situation quickly changed after the meeting details revealed a discussion to limit prescriptions to four boxes per year (each box containing 60 vials), which was considered a radical measure. During the National Assembly audit in October, concerns were raised about reduced patient access for seniors and potential price surges for non-reimbursed products. Faced with these issues, the government refrained from making a hasty decision. In December 2023, during the secondary review, it was decided that further review was necessary. The MOHW's Health Insurance Policy Review Committee also recommended establishing reimbursement criteria for hyaluronic acid eye drops and other single-use ophthalmic solutions to prevent a balloon effect. The review results were published in the administrative notice on drug reimbursement criteria on November 15. As per the Health Insurance Policy Review Committee's recommendations, to prevent a balloon effect where prescriptions shift from hyaluronic acid eye drops to six other single-use ophthalmic solutions, reimbursement will be limited to only one type of eye drop for keratoconjunctivitis sicca. However, the final proposal can be seen as a step back from the primary re-evaluation results from last year. In 2023, reimbursement for hyaluronic acid eye drops was excluded for extrinsic conditions. In contrast, the final draft now allows reimbursement for cases diagnosed as persistent intrinsic corneal and conjunctival epithelia following extrinsic conditions, effectively expanding the scope of use compared to the first re-evaluation result. The usage limit for hyaluronic acid eye drops has been set at a maximum of six vials per day, typically three boxes (60 vials per box) for 30 days. It is a much more lenient policy than the primary draft of a four-box annual limit. Given the social controversy surrounding this issue, it is presumed that the final decision was made with exceptional caution. The final draft likely has been designed to minimize backlash by considering patient access, the perspectives of prescribing healthcare professionals, and other relevant factors. However, it seems inevitable that the scientific standards for evaluation, such as clinical utility and cost-effectiveness, were somewhat relaxed during the process. Comparing last year's primary results from the DREC with the final proposal, it is likely that many would feel this way. We respect the final draft because social demands are also significant. Even so, was it necessary for the re-evaluation to take a year? By the time the 2024 reimbursement appropriateness re-evaluation was completed and the National Assembly audit concluded, the issue had almost faded from memory. Releasing the final draft at this point is close to dereliction of duty. If the final draft had any potential cost-saving effects, it is fair to say that a year of savings was lost due to the delayed conclusion. Furthermore, analysis suggests that the delayed decision likely resulted in considerable damages, including uncertainties and chaos in the practices. The government must elaborate on the analysis of re-evaluation results of single-use eye drops and the background of taking an entire year.
- Opinion
- [Contribution] On MFDS’s new drug approval fee hike
- by Whang, byung-woo Nov 21, 2024 05:46am
- Kyung-won Seo, Chair Professor, Department of Food& Medical products Regulatory Policy, Dongguk University The Ministry of Food and Drug Safety recently announced a significant rise in its new drug approval fee to KRW 410 million. In Korea, the new drug approval fee had remained very low at KRW 8.83 million for decades, compared to the US FDA's KRW 5.3 billion, the European EMA's KRW 490 million, and the Japanese PMDA's KRW 430 million. The fee hike had been long desired by the industry and the MFDS alike, and the MFDS had worked hard to raise the fee. So the significant increase in the new drug review fee means that the value of the new drug review work being carried out by the authorities has been properly recognized, which the MFDS and the MFDS members in charge of new drug approvals should be proud of. Congratulations and a big round of applause to MFDS for their hard work and this long-awaited achievement. Since a new drug is a substance that has never been administered to humans before, the development company must conduct extensive experiments to confirm the quality, safety, and effectiveness of the new drug, and regulatory authorities must evaluate the adequacy of its process and results. The process of reviewing new drug data requires a large number of experts from regulatory agencies and takes more than a year, so the labor cost of this process is reflected in the new drug review fee, which renders the fee high. The industry has been receiving the news with mixed emotions – welcoming the long-awaited increase of the new drug review fee but then panicking at the unexpectedly large increase. As the industry will be paying a significant amount - KRW 410 million – it will expect high-quality regulatory services. The MFDS’s announcement of the 'Innovative Plan for New Drug Approval' along with the administrative notice of the 'Fee Regulations for Drug Approvals, etc.' is an expression of its strong will to provide high-quality regulatory services that can meet industry expectations. Until now, the biggest complaint of the industry has been the unpredictable review period/approval date of new drugs. A particularly notable part of the MFDS’s innovation plan is that it will shorten the review period from an average of 420 business days to 295 calendar days. Unlike other countries, the MFDS’s review period is calculated in working days and does not include the time spent by the company preparing the data, so the total review period was delayed by 420 days on average, even if the statutory deadline was not met. If the review period for new drugs is shortened to 295 calendar days, the Korean public will benefit by using innovative new drugs with verified efficacy and safety sooner, and the industry will receive the greatest gift of all: predictability in their approval. In order for the MFDS to meet the actual 295-day timeframe, it will need to recruit a large number of highly qualified reviewers with expertise, conduct a thorough prior review to ensure that supplemental requirements that require significant time to prepare do not arise during the review process and harmonize review regulations internationally to ensure that no data or tests are required only by MFDS. As most of the delays had occurred due to requests for supplementary data that require a significant amount of time to prepare, to prevent this from happening, a thorough preliminary review should be conducted and a system put in place to prevent the application from being accepted if it lacks required data. Once the application has passed the preliminary review, the 295-day review period promised by the MFDS must be met. Looking more closely at the reasons for the delays in the review period for new drugs, it can be assumed that there are still test items and data that only MFDS requires, and the preparation of these materials by supplementation was a factor in the delay. Since Korea became a member of the ICH, most of the guidelines have been internationally standardized, but there are still items that need to be improved, and this fee hike is the opportunity to harmonize the details of the review regulations internationally. With the development of the pharmaceutical industry and the advancement of new drug evaluations, the number and volume of review materials have increased dramatically, and the depth and complexity of the contents have reached a level that is incomparable to the past. So the reviewers of regulatory agencies who have to evaluate these materials are required to have the highest level of professional capabilities. Although the MFDS has been making great efforts to secure these talents, it has not been able to secure competent reviewers at the level of advanced regulatory organizations due to various constraints. Now that the new drug review fee has been raised to the level of advanced regulatory organizations, everyone is expecting that the MFDS will attract a large number of reviewers who own the best expertise. The increase in new drug reviews is expected to open a new era where various review innovations begin to be introduced. For the new system to take off and succeed, the MFDS, industry, and academia must continue to communicate, coordinate, and improve the system through open discussion. The MFDS has been working with many partners, including the industry, to become an advanced regulatory organization. I expect that the MFDS will continue to move forward step by step with its long-standing partners to become the world's leading regulatory agency, and I extend my warmest support to the MFDS as one of its former members and now one of its most enthusiastic supporters.
- Opinion
- [Reporter’s View] Who’s to blame the new drug reimb delays
- by Eo, Yun-Ho Nov 15, 2024 05:49am
- Expedited approval of new drugs is one of the oldest issues in the pharmaceutical industry. Shortening the insurance reimbursement review period for drugs has been discussed almost every year, and in fact, the regulatory deadline is getting shorter and shorter. This is true for both the evaluation and negotiation stages of the Health Insurance Review and Assessment Service and the National Health Insurance Service. However, it is also true that the deadline is only a deadline set for the pharmaceutical company to apply and the authorities review the application, so it is not proving to be effective in expediting the reimbursement of new drugs. The responsibility lies on both sides. First of all, many pharmaceutical companies spend a considerable amount of time between the post-approval feedback process with their respective headquarters before actually applying for reimbursement - in other words, taking their time weighing up the gains and losses. During this process, the companies may delay the timing of reimbursement to receive a higher price or give up some indications due to competition from other products. Some companies deliberately delay drug price negotiations in anticipation of being included in the government's new coverage plan, while others cancel the introduction of a drug altogether because they believe it is not marketable in Korea. The “Korea-passing” decision, where the companies forego Korea and introduce the drug to other countries first, has become commonplace. In fact, at a recent press conference, HIRA said, “Regarding the time it takes to reimburse a new drug, although the evaluation is carried out within the statutory deadline, there is a difference in the actual time taken to the listing because the companies take a considerable amount of time to supplement their data, etc. In order to quickly register a new drug, the companies must first faithfully complete documents when applying for a decision.” However, the government's “let's complete discussions in the earlier stages and send the agenda to the Drug Reimbursement Committee” decision also plays a role. If you trace back the process of listing a drug that is long overdue for listing, there are certainly cases where the companies had voluntarily withdrawn their application after the Drug Reimbursement Standard Subcommittee decided to delay the review. However, there are many cases where such withdrawal is not “voluntary.” The deferral decision is very common during drug pricing negotiations between the NHIS and pharmaceutical companies. However, we need to remember that the 60-day deadline set for negotiations is a promise, and a deadline is a deadline. Also, the NHIS has referred to the negotiation deadline as a sort of "benefit" when announcing its plan to shorten the deadline for new drugs. The problem is that there is no transparency in the progress made in those 60 days. Nothing is disclosed on what happened to the drugs that exceeded the listing review deadlines. As a result, only the patients are left to suffer in endless await. No answer nor explanation on the direction of progress is provided to those who wait in dire need. This new year, all the stakeholders involved should make collaborative efforts to reduce the period to actual reimbursement listing.
- Opinion
- [Reporter's View] The reality of drug shortage reports
- by Lee, Hye-Kyung Nov 14, 2024 05:52am
- Reports of shortages of oxytocin, an injectable drug used primarily as a labor inducer, have caused confusion in the obstetrics and gynecology field. Most obstetrics and gynecology centers that have a large number of expectant mother visits stock enough oxytocin to last 2-3 weeks, but JW Pharmaceuticals, which holds more than 70% of the prescription market, has announced a shortage of its oxytocin supply that will last until January next year. In the case of childbirth, there is no reason for a sudden surge in a drug’s demand like infectious diseases or colds, but oxytocin is designated as a national essential medicine that must ensure a stable supply as it is used to induce labor in mothers. In Korea, only two companies, JW Pharmaceutical and Yuhan Corp, manufacture oxytocin drugs. Since it is a national essential medicine with a small number of manufacturers, it seemed natural that supply and demand management would be in place, but out of the blue, the clinics and hospitals were suddenly just told that “there was no medicine.” A small hospital in a rural area with a low birth rate would have ordered the medicine on a case-by-case basis rather than keep two to three weeks' worth on hand, so the news that it would soon be out of stock must have been like a bolt from the blue. The question that first came to mind was, why is there a national essential medicine system in place if it cannot manage the supply of essential drugs? When looking closer into the situation, the cause was clear: the system was not well established enough to ensure a stable supply of the necessary drugs. The discontinuation of the manufacture, import, and supply of finished drugs must be reported to the Ministry of Food and Drug Safety 60 days before the discontinuation date. However, as the criteria for reporting shortages are set differently in each company's SOP, and there is no absolute threshold set for determining drug shortages. In the case of oxytocin, the MFDS was able to identify the shortage only after looking into Yuhan Corp’s shortage report, a company that only accounts for about 30% of the oxytocin market share. On October 28, the company reported a shortage of oxytocin on the market, stating, “There is also supply disruption for Choongwae Oxytocin Inj.. which is approved with the same ingredient. With no substitute drug available containing the same ingredient, a supply shortage is expected for a period of time, but we will be able to ensure supply from November 14, 2024.” Up until this point, JW Pharmaceutical had not notified the MFDS of its shortage. The problem was that the MFDS was not informed, but the letter sent to obstetrics and gynecology clinics and wholesalers indicated that the drug would be “out of stock until January.” Even if the drug is designated as a national essential medicine, the KFDA cannot know about the shortage without a report from the pharmaceutical company. The MFDS began to investigate the situation when it learned about JW Pharmaceutical’s oxytocin shortage via Yuhan Corp’s supply shortage report. JW Pharmaceutical, which has a higher market share, was unable to manufacture finished drugs due to issues with the API, and the MFDS reportedly supported the necessary measures and moved up the manufacturing date from January next year to December this year. This situation seems to have occurred because the threshold for shortages was not specified. Each company had a different threshold set for sending “out of stock” reports to the MFDS. Yuhan Corp reported a shortage when it crossed its threshold of shipments this year, while JW Pharmaceuticals did not report a shortage until it was likely to run out on site. It's not easy for the MFDS to keep track of the shortages of more than 500 national essential medicines every day. Unless the ministry receives a proper report, they cannot provide the necessary support, but if the product becomes out of stock even before the ministry can consider support, there is no opportunity for the authorities to take action. As a result, no medicine is available on site, with the government ending up taking countermeasures after the damage is made. Last year, the Ministry of Food and Drug Safety revised the Ordinance of the Prime Minister to pull forward the drug shortage report from 60 days to 180 days, with implementation scheduled for April next year. However, if the regulation is revised without a baseline for reporting not established, cases like oxytocin will only repeat itself. We need a system to address stockouts before there is “no medicine” on site.
- Opinion
- [Reporter's View] voluntary resignation with compensation
- by Lee, Seok-Jun Nov 13, 2024 05:54am
- As the year-end is nearing, several pharmaceutical companies are considering restructuring. Rumor has it that these companies may have plans for reducing OTC businesses and laying off staff who are age 55 or older. It remains uncertain whether it is a rumor or an actual plan, but restructuring could be possible. Over five pharmaceutical companies that were mentioned. There is a solid reason companies have chosen restructuring. It is for business efficiency. Restructuring could be an enormous benefit if laying off results in efficiency within the company. It is an approach of 'selection and focus,' losing a few if taking all is not an option. Voluntary resignation is frequently used as a method of job cuts. It is implemented to reduce the number of employees at once. It is the same as layoffs in business. However, companies utilize the voluntary resignation program instead of layoffs because layoff requirements are selective according to the Labor Standards Act and may result in conflicts and management. Korean pharmaceutical companies employ a similar method. Voluntary resignation is less frequent than that of the multinational companies, but the Korean companies have used it more often recently. At the end of last year, Korean mega-pharmaceutical companies, Ildong Pharmaceutical and GC Biopharma, conducted voluntary resignations. Likewise, Korean pharmaceutical companies are favor voluntary resignation when reducing the number of employees. Then, what is the next important step? We must consider compensation for those who are subjected to restructuring. Pharmaceutical companies' goal for restructuring is to reduce the number of employees. However, it would be better to achieve such a goal by offering a good compensation package. If restructuring is inevitable, a win-win structure must be set. Although companies may have to spend a large sum of money at once, they may have to sacrifice considering the cost-effective outcomes in a few years following restructuring. Yet, a compensation criterion has not been established for voluntary resignation. Compensation criterion vastly differs by company. Direct comparison may be difficult, but the criterion in Korean companies is different from the (consecutive years of service*2)+ N months in multinational companies. Few companies urge voluntary resignation without compensation. Companies will continue to undergo restructuring. Then, it will be necessary for Korean companies to establish a compensation criterion for voluntary resignations. Precedence will serve as a standard for those who follow. If leading restructuring companies set low compensation, latecomers will also set low standards. The situation in small and medium-sized companies will be much worse, causeing a vicious cycle. Now, an agreement between Korean companies for voluntary resignation compensation may be necessary. Better compensation will lessen the backlash from restructuring.
- Opinion
- [Reporter's View] Patience is required to foster K-Bios
- by Whang, byung-woo Nov 12, 2024 05:51am
- The performance of the domestic pharmaceutical bio industry is being evaluated with the approaching end of 2024. This year, the increased influence of domestic companies in the fields of biosimilars and CDMOs (contract development and manufacturing) and the technology transfer performance of bio ventures have been positively evaluated. However, there is also a view that the investment in venture firms has slowed down due to the overall stringent investment market and that the government's plans to foster the bio-industry are still fragmented across ministries. This is why the outlook for the domestic bio industry next year is also a mix of concerns and expectations. First of all, the biggest change is the launch of the National Bio Committee, chaired by the president. Although the Bio Health Innovation Committee under the Prime Minister was created last year, the industry has been emphasizing the need for a control tower to comprehensively manage the bio sector, so there are high expectations for the establishment of the top-level national bio policy deliberation body. While there are doubts over to what extent the National Bio Committee will be able to play its role, it is a timely creation as it will be able to address the larger discourse. In addition, the Korean version of ARPA-H, which will begin to kick off next year with the selection of companies, is also a positive bonus for the bio industry. It is also encouraging for the industry as the program is benchmarked after ARPA-H in the US and considers 'process over outcome'. In addition, the expected benefits for the bio industry from the election of Republican candidate Trump as president of the United States are also considered an opportunity for K-Bio to seize. During his candidacy, Trump considered lowering drug prices for new drugs and biosimilars to reduce the burden of medical expenses, and plans is open up the closed domestic market to overseas companies and induce competition. Korean companies will be forced to compete in the global market, but another way of looking at it is that the door will become open to all. Despite this good news, the industry is still arguing that it needs 'time' to foster the industry. While there are domestic pharma and biotech companies that are performing well overseas, it is strictly limited to a few companies. Another limitation is that the government's efforts, such as the National Bio Committee and the Korean ARPA-H project, are still in their early stages. In fact, there is no guarantee that things will go as expected, just as the government's ambitious K-Bio-Vaccine Fund investment project is struggling to raise funds due to low expectations. Government interest is like a double-edged sword. They want to see quick results for their support. For this reason, the industry is emphasizing the creation of an ecosystem rather than a near-sighted view to foster the industry. This is also a challenge for governments, who need to show results, as building ecosystems is vague and hard to visualize. However, relying on a few companies to produce tangible results may not be enough to foster the growth of the entire bio industry. Just as a deeply rooted tree on a solid foundation is not easily shaken, deep consideration of the ecosystem is necessary to establish the bio industry as Korea’s core national strategic business.
- Opinion
- [Reporter's View] Regarding the obesity drug craze
- by Son, Hyung Min Nov 08, 2024 05:46am
- There is one research and development item that is gaining explosive popularity among both global and domestic pharmaceutical companies –obesity treatment. The use of obesity drugs has also increased dramatically with the significant rise in the number of obese people around the world. Global sales of obesity drugs reached USD 6.68 billion (about KRW 9 trillion) last year, up 145.6% from USD 2.72 billion in 2022. In particular, the success of glucagon-like peptide (GLP-1) receptor agonist obesity drugs such as Saxenda, Wegovy, and Zepbound has attracted the attention of domestic and foreign pharmaceutical companies to GLP-1 drug candidates. Saxenda posted sales of KRW 1.225 trillion last year, up 9.8% YoY. Wegovy’s sales surpassed KRW 300 billion last year despite facing supply difficulties. GLP-1 was originally developed as a diabetes treatment. However, GLP-1 drugs took a major turn when Novo Nordisk's liraglutide and semaglutide showed effect in weight loss. During clinical trials of its antidiabetic drug liraglutide (trade name Victoza), Novo Nordisk noticed a weight loss effect among its enrollees. Based on the findings, the company changed the dose of liraglutide and developed Saxenda, a GLP-1 drug for obesity. The company used the same mechanism to develop Wegovy with semaglutide (Ozempic). Both Saxenda and Wegovy are now in the global market, and their non-reimbursement prices have surged with their increasing popularity. The problem is that the promise of effective weight loss through simple injections has led to increased use for cosmetic and dieting purposes. There has been a significant increase in prescriptions for weight loss in people who are not overweight and obese or chronically ill. The popularity of dietary supplements with unproven efficacy and side effects is also on the rise. However, manufacturers only highlight the weight-loss benefits of GLP-1 drugs and neglect to warn consumers about their side effects. GLP-1 receptor agonists are associated with various side effects. Side effects of GLP-1 class drugs include muscle loss, acute kidney disease, nausea, vomiting, and diarrhea. In the United States, a recent case of acute pancreatitis was reported as a side effect of an anti-obesity drug, resulting in death. Unlike diabetes, obesity is not classified as a disease and is therefore treated without reimbursement benefits. Although it is classified as a risk factor for various metabolic diseases, such as dyslipidemia and hypertension, it is not regarded as a condition that requires medication. The first treatment recommended for obese patients who visit an endocrinologist is lifestyle modification. If the weight remains uncontrolled after lifestyle modification, doctors will consider using a medication, but they are cautious about doing so because of the side effects that come with it, including rebound weight gain. While the overprescription of obesity drugs for cosmetic purposes is a serious problem, the lack of information on its side effects seems to be a major contributor to the misuse and abuse of obesity drugs. The role of the pharmaceutical industry, which has developed and is developing obesity drugs, is also important. While it is necessary to publicize how much weight loss is achieved with the use of each drug, it is also time for the public to be fully informed about their side effects. “Miracle drugs” that can dramatically reduce weight are not free from side effects.
- Opinion
- [Reporter's View] Address Actions to drug substitution
- by Lee, Jeong-Hwan Nov 01, 2024 05:51am
- "We will foremostly activate drug substation to resolve the drug shortages issue," Cho Kyoo-hong, Minister of Health and Welfare (MOHW), promised during the parliamentary audit session commenced by the National Assembly's Small Committee for Health and Welfare. This is an answer from the MOHW director to an issue of essential medicines frequently in shortage, leading to chaos in pharmacies and lower patient access to medications. The issue has been unresolved for several years. Rep. Seo Youngseok and Rep. Nam In-soon of the Democratic Party of Korea have requested the implementation of active ingredient prescriptions for cold medicines and essential medicines to resolve the issue of frequent drug shortages. Minister Cho repeatedly answered that he would improve the current situation by enabling drug substitution rather than active ingredient prescription, as the latter requires agreements between officials. According to Minister Cho, activating drug substitution beyond the current 'lower-cost drug substitution incentive' policy by the Health and Welfare Committee requires specific administrative actions, policy establishment, and implementation. In other words, their plan cannot be attained by the way MOHW said to actively participate in the legislative session to review the National Assembly submitted bill for simplifying drug substitution procedure. Passing the plenary session of the National Assembly for the bill for implementation of drug substitution that has been submitted to the National Assembly would take several months after undergoing the legislative process. It has not been considered for the Legislation and Judiciary Small Committee for Health and Welfare. During the legislative procedure, it is unknown whether the bill would face opposite opinions, overcome oppositions, and pass all legislative hurdles. During the parliamentary audit, the MOHW answered a question about the restricted implementation of active ingredient prescriptions for cold medicines by stating, "It is the terms of the medical reform agreement. Therefore, the issue requires societal discussion and a procedural agreement." Then, the MOHW must consider detailed and active administration to implement drug substitution to resolve frequent drug shortages of cold medicines and pediatric medicines. In particular, lower-cost drug substitution must be increased because the government provides incentives to strengthen the stability of the National Health Insurance finance. According to the Health Insurance Review and Assessment Service (HIRA), the incentive for drug substitution increased temporarily during the COVID-19 pandemic. After the announcement of 'With COVID-19," it returned to that of pre-COVID-19. It shows that drug substitution policy has been conservative and passive unless drug substitution is inevitable, such as during the pandemic period. Not only during this audit but also during the previous parliamentary audit, the MOHW had agreed to the necessity of supporting drug substitution and increasing the incentive rate for lower-cost drug substitution. However, the concern is that they have not suggested a concrete method to specifically address when and how drug substitution can be actively implemented. As Minister Cho promised during the parliamentary audit that he would actively implement drug substitution to resolve the drug shortages, the MOHW must provide incentives and establish an administrative policy so that pharmacies can dispense drug substitution for drug shortages without hesitation. We must not passively wait for the legislative procedure after agreeing to the bill to simplify drug substitution, which is to be reviewed by the National Assembly. Aside from passing the bill to the National Assembly, we hope to hear about MOHW's updated policy to support drug substitution in resolving the drug shortage issue by actively implementing it.
