↑63% of the average annual SA bill

57% of ultra-high-priced claims

Claims surged from 31.9 billion won in 2014 to 959 billion won in 2021

Among ultra-high-priced drugs with an annual drug cost of more than 10 million won per patient, RSA contract drugs have increased significantly.

 

It was confirmed that the claims for RSA drugs increased by an average of 62.6% per year.

 

This fact was found in the "Research on the Performance Evaluation and Development Direction of RSA" conducted by the Industrial-Academic Cooperation Group of Seoul National University (Professor Lee Tae-jin), at the request of the NHIS.

 

The results of this study were partially released on the 2nd through the management information disclosure system (Alio) of public institutions.

 

The research team surveyed the cost of claiming risk-sharing drugs among high-priced drugs exceeding 10 million won per year from 2010 to 2021, and the number of RSA drugs increased from 31.9 billion won in 2014 to 959 billion won in 2021.

 

The amount is equivalent to an average annual increase of 62.6%.

 

RSA drugs accounted for 57% of the total 1.6927 trillion won in claims for expensive drugs in 2021.

 

RSA emergency high-priced drugs increased only 4.9% annually from 50.8 billion won in 2014 to 65.8 billion won in 2021.

 

The research team evaluated, "The RSA system seems to have provided new opportunities for high-priced drugs." In the meantime, he suggested financial management measures for expensive drugs that need to check the RSA system and evaluate the performance of the financial-based types, Refund type, and Expenditure Cap type.

 

However, the research team added, "One-shot treatments, which have recently received great attention, are not included in this analysis, so we propose additional analysis including one-shot treatments in the future, and in the long run, it is necessary to establish a high-priced financial monitoring system based on this data extraction and analysis." The research team also said that it is necessary to prepare financial management measures for RSA non-emergency drugs.

 

The research team explained, "Among non-RSA drugs, anti-cancer drugs are not expensive, and hemophilia drugs and enzyme drugs are high," adding, "Hemophilia drugs are worth 200 billion won in 2021, and enzyme drugs are worth 100 billion won, which has steadily increased." "Unlike RSA drugs, where financial uncertainty is managed, non-RSA drugs have no financial management plan other than price cuts at the expiration of patents," he said.

 

"It is necessary to review re-evaluation or renegotiation considering environmental changes such as changes in foreign prices and listing alternative treatments." The research team said, "To reduce the uncertainty of ultra-low benefit, different approaches are needed depending on the type of uncertainty, the prospect of resolving uncertainty, and decision-making uncertainty.

 

If the primary goal is to apply the CED method, it is better to apply the refund or Expenditure Cap type." As of July 2022, a total of 60 drugs were found to have signed RSA contracts.

 

Anti-cancer drugs and rare disease treatments have increased their registration rates since the introduction of risk-sharing systems, and from 2015 to 2021, the drug cost of risk-sharing drugs increased by 50.9% annually, and RSA drugs averaged about 1.8 million won.

 

RSA is an anticancer drug or rare disease treatment without an alternative and can be applied to serious diseases, omitted drugs submitted by PE, or phase 3 conditionally licensed drugs.

 

When the NHIS RSA contract is signed, pharmaceutical companies will refund a certain percentage to the corporation based on their finances and performance.