dailypharmkorea

Opinion
[Reporter’s View] Long-awaited, but not prescribed?
by Eo, Yun-Ho Feb 08, 2024 05:49am
Even though the only existing treatment on the planet has finally been approved for reimbursement in Korea, prescribers are hesitant to introduce the drug to their institutions due to concerns over incurring losses if the costly drugs are not used. These are drugs that have gained much attention since approval. The drugs showed outstanding efficacy in diseases with no or limited treatment options, but are expensive. Upon their entry into Korea, patients and their families had been desperately arising for their insurance reimbursement. In every stage of the process, from when the pharmaceutical company applied for reimbursement benefits to the Health Insurance Review and Assessment Service, to every step of the listing process by the National Health Insurance Service, attention was gained and petitions were filed, prompting its listing. However, to the public’s disappointment, the approval process for new drugs that bring heavy financial burdens on national health insurance is usually not smooth and takes a long time. But often, these new drugs that passed this rough and difficult reimbursement process are not being prescribed at most hospitals. And these aren’t all gene therapies that require specific facilities for their prescription. One drug, which was listed almost half a year ago, has only landed in a handful of medical centers in the country despite being an unprecedented and reimbursable treatment. This is because hospitals are reluctant to bear the loss that may occur if the government orders insurance cuts after the drugs are prescribed at the discretion of their physicians. The same is true for the distributors. If they incur a loss in the process of distributing these drugs, they lose a lot of money. The same goes for drugs that require preapproval. The preapproval system is a system established to review whether or not to reimburse expensive rare disease drugs for each patient in advance and is designed to improve patient access to treatments while protecting health insurance finances. It has two functions: prior review, which determines the eligibility of the patients before treatment, and concurrent review, which determines whether the patient may continue treatment with reimbursement after the preapproval. In other words, because the drug is so expensive, the authorities are using prior review to determine whether or not the drug can be reimbursed, case-by-case. The drugs that require prior review can also prescribed when there is an emergency at the doctors’ discretion. The problem lies in when the drug is prescribed but the authorities decided to reject its coverage. It’s not right to ask the hospitals and distributors to just bear the losses. But we all need to remember that much yearning and hard work went into reimbursing the drugs. Hospitals and distributors need to work with the industry and authorities to fulfill the purpose of the ‘risk-sharing’ scheme. This is not the time to be reluctant, it is rather the time to take a proactive step forward. The government also needs to understand this hesitation on-site in using drugs that have entered the system. ‘Landing’ shouldn't become one more barrier that contributes to ‘drugs that exist but can't be taken or administered’ in addition to reimbursement.