Drug price lawsuit recovery & refund, effective on the 20th

The contents to be notified by the pharmaceutical company

Ministry of Health and Welfare promulgates the enforcement rules of the Health Care Act..."Repay the loss to the pharmaceutical company within one year from the date of the court's ruling"

Pharmaceutical company to reduce drug price, abusing lawsuit to reduce 'term profit' strategy In order to recover or refund the loss of drug costs as a result of the drug price-down lawsuit, the NHIS must notify the pharmaceutical company of the details such as the amount of refund, method, and the deadline for submitting opinions.

 

The Corporation of Public Security shall refund the amount of the amount of loss to the pharmaceutical company within one year from the date of the administrative trial or administrative lawsuit's citation review, or judgment is confirmed.

 

The amount of loss is calculated as 100% of the difference in the drug price in the case of a reduction, 40% of the difference in the drug price in case of suspension or exclusion, or reduction.

 

On the 14th, the Ministry of Health and Welfare issued a partial revision of the Enforcement Rules of the National Health Insurance Act.

 

The revised enforcement rules will take effect on the 20th, when the Drug Refund and Refund Act comes into effect.

 

Specifically, the Ministry of Health and Welfare has established a new provision in the Enforcement Regulations of the Health Care Act, such as 'Collection and payment procedures for equivalent losses when disputes 60-2 drugs'.

 

The relevant provision stipulated the matters that should be notified in advance when the Korea Medical Security Corporation collects or pays the amount of losses caused by the suspension or cancellation of drug price in accordance with paragraphs 1 and 2 of the health and 2 of the health security Act, which stipulates the Drug Expenses Repayment and Refund Act.

 

In addition, the attached details such as the standard for calculating the amount of loss and the standard for calculating the added money corresponding to interest have been specified.

 

The Corporation shall include in the notice the name (name or business name of the corporation), address, etc.

 

of the pharmaceutical manufacturer, from the reduction of the upper limit on the cost of the drug care benefits, that is, the drug price is, but the title of the suspension or adjustment of the application of medical care benefits, and the drug manufacturer's name and address.

 

Details such as the amount of loss caused by the drug price-down lawsuit, the calculation of the increase, the method of loss payment and payment, and the deadline must be notified in advance, and if you do not submit the opinion of the target pharmaceutical company, you must also present the processing law.

 

At this time, the period for pharmaceutical companies subject to drug recovery should be 10 days or more from the date of receipt of notice from the Corporation.

 

After the opinion submission period, the Corporation must send a payment notice when collecting (refunding) the loss, and a document stating the reason for payment, payment amount, payment method, and expected payment date at the time of payment (refund) to the target pharmaceutical company.

 

The Corporation shall pay the loss to the pharmaceutical company within one year from the date the citation decision or judgment of the administrative trial or administrative lawsuit is finalized.

 

The criteria for calculating losses and extra money are in accordance with Schedule 82 of the Enforcement Regulations, and other details related to recovery and refunds can be determined by the chairman of the Corporation after approval of the Minister of Welfare.

 

According to Table 82, which stipulates the criteria for calculating the loss and the added money, 100% of the drug price difference that occurred during the period when the drug price was stopped due to the administrative trial committee or the court's suspension of execution in the case of the dispute over the drug price drop disposition, and 100% of the drug price difference that occurred during the period when the administrative trial or administrative lawsuit decision is finalized from the time of drug price.

 

In the event of a dispute over suspension, exclusion, or reduction, 40% of the approximate price difference is a loss.

 

With the promulgation of the revised enforcement rules of the Ministry of Welfare, all the work on sub-laws related to the drug price recovery and refund system scheduled to be implemented on the 20th has been completed.

 

The Ministry of Health and Welfare expects that the implementation of the drug price reduction and refund system will reduce the number of indiscriminate suspension and cancellation lawsuits of drug price reduction, significantly reducing the amount of health insurance finances.