All domestic restrictions on PVA cut are agreed

173 out of 175 Type C agreed

April revised guidelines completed without resistance to retroactive application

정해민 건보공단 약제관리실장이 23일 전문기자협의회와 브리핑을 하고 있다.

Jeong Hae-min, head of the NHIS Pharmaceutical Management Office, is briefing with the Korea Special Press Association on the 23rd.

 

In the PVA negotiations that reflect this year's revised guidelines, all domestic pharmaceutical companies agreed with the NHIS.

 

Initially, negotiations with some domestic pharmaceutical companies were expected to be difficult due to opposition to the retroactive application of the revised guidelines, but they reached an agreement within the target deadline.

 

The agreed items will be reviewed by the Health Insurance Policy Review Committee this week and announced on September 1.

 

Jeong Hae-min, head of the NHIS Pharmaceutical Management Office, explained in a briefing with the Korea Special Press Association on the 23rd that 173 out of 175 items subject to negotiation were agreed.

 

Type A negotiations are subject to an increase of more than 30% of the expected claims negotiated with the NHIS, and a product which cap has been adjusted by type price negotiations has increased by more than 60% or 10% from the previous year and increased by more than 5 billion won.

 

This year's type C negotiations drew attention as the revised guidelines were reflected in April.

 

The revised guidelines exclude less than 90% of the arithmetic average of the same main ingredient code and less than 2 billion won in annual claims from the negotiations.

 

Previously, less than 100% of the arithmetic average and less than 1.5 billion won in annual claims were excluded.

 

As a result, products from small and medium-sized pharmaceutical companies with an annual billing amount of less than 2 billion won will be excluded, but drugs with an arithmetic average of less than 90% will be included in the list, increasing the possibility of a drug price cut.

 

In response, some pharmaceutical companies and the KPBMA have suggested that the guidelines should not be applied retroactively as of the previous year.

 

However, regarding the retroactive application, the NHIS expressed its intention to reject it and began negotiations with individual pharmaceutical companies, saying that it shared it through meetings such as public-private consultative bodies.

 

Jeong said, "We completed negotiations with individual pharmaceutical companies through sufficient consultation with pharmaceutical companies when negotiating with each company." As a result of the negotiations, an agreement was reached on 173 items in 52 product lines out of 175 items in 53 same product lines from 37 companies.

 

Two items of one product line will be renegotiated, and the product is known to be two items of Xigduo XR of AstraZeneca Korea.

 

Chief Jeong said, "The average cut rate of items that have been negotiated has decreased from last year, but the amount of fiscal savings has increased from last year." According to the revised guidelines, the average claim for drugs added due to the adjustment of the arithmetic average price was about 16.23 billion won, and the average claim for drugs excluded due to the upward revision of the claim was about 1.7 billion won.

 

Director Jeong added, "As with the goal of revising the guidelines, we can see the reduction in administrative costs due to the exclusion of negotiations on drugs with small claims and the expansion of follow-up management of drugs with a large impact on insurance finances."