75% of patients who administered Kymriah is not effective

99 out of 130 people don't have a meaningful performance

Zolgensma, 88% significant improvement has been confirmed for patients

More than 75% of patients who received the ultra-high-priced drug Kymriah, which costs 360 million won in one dose, did not have an improvement effect.

 

On the 6th, Kim Young-joo, a member of the National Assembly Health and Welfare Committee (the Democratic Party, Yeongdeungpo Gap) received data from the Health Insurance Review and Assessment Service on the 'Current status of administration of ultra-high-value drugs such as Kymriah and Zolgensma and patient response evaluation'.

 

The world's first CAR-T treatment drug, Kymria,h has an indication for the treatment of adult patients with ▲post-transplant recurrence or secondary recurrence and subsequent recurrence or impresistible B cell-grade lymphoma in children and young adult patients under the age of 25 ▲reactive or non-resistible large B-cell lymphoma (DLBCL) after two or more systemic treatments.

 

Since April 2022, health insurance benefits have been applied, and the patient's copayment has been reduced to a maximum of about 6 million won.

 

Zolgensma, a treatment for spinal muscular atrophy (SMA), costs 1.98 billion won for a single dose of non-paid.

 

Zolgensma was reimbursed in July 2022.

 

Since December 2022, the HIRA has been operating a 'high-drug management system' that monitors the dosing information of ultra-high-drug patients such as Kimlia and Jolgensmaju and the evaluation of the response to drugs after administration.

 

Kymriah had 146 patients who were dosed after reimbursement.

 

Of these, there were 21 cases of pediatric leukemia and 125 patients with megabloid B-cell lymphoma.

 

Their salary contract cost was 52.6 billion won.

 

Jolgensmaju was dosed by 12 people and the cost of the payroll was 23.8 billion won.

 

The cost-effectiveness of these ultra-high-securing new drugs is unclear, so it is implementing a 'patient-based risk-based risk-sharing system' so that the pharmaceutical company will refund a certain percentage of the amount to the healthcare company according to the contract if it is ineffective by tracking the treatment performance of each patient.

 

According to the HIRA, as of August this year, 130 patients with lymphoma who had been treated with Kymriah for 6 months had submitted a response evaluation, of which 99 were classified as eligible for refunds.

 

This means that more than 75% of Kymriah patients did not have a significant improvement effect.

 

Only 1 out of 9 patients who submitted the results were eligible for reimbursement, and more than 88% of patients who received Zolgensma had the treatment effect.

 

Health insurance and pharmaceutical companies negotiate to set the refund ratio, but the refund ratio is kept private.

 

In the case, it is known that the refund rate is less than 50% even if there is no medicinal effect, and the refund rate is more than 50% for Jolgensmaju.

 

The problem is that hundreds of billions of dollars are spent on medicines with low treatment performance.

 

Rep.

 

Kim Young-joo suggested, "In order to prevent blind spots, the target of the benefit should be expanded to patients who need ultra-high-paying treatment, such as Kymriah and Zolgensma.

 

However, it is necessary to increase the refund rate of pharmaceutical companies if there is no treatment effect by strengthening the risk-sharing agent for the sustainable benefits of ultra-high-high-high-high-mouth new drugs." In addition, he emphasized, "The system should be improved so that patients can receive a certain part of the refund if there is no treatment effect because the patient's own burden is high even after paying," he emphasized.