Gov will proactively improve system for severe psoriasis

MOHW·NHIS·KPA holds meeting

Despite reimbursement approved for the psoriasis drugs, the high standards set for their registration make it difficult to apply

Patient group requests transparent discussion over the standards as an agenda at the sSpecial Exemption of Calculation Committee meeting

With a year left before the re-registration of special exemption of insurance calculation for severe psoriasis, the government, payer, and patient group gathered to discuss improvement.

 

The issue discussed was that despite reimbursement approved for severe psoriasis drugs, patients are not being properly covered as the eligibility standards for the special calculation system are too strict, which increases the actual cost borne by patients.

 

The patient group appealed to the government and payers that the standards for severe psoriasis should be set at the same level as other severe incurable diseases rather than solely relying on expert opinions, and the authorities said that they will take a proactive stance in resolving the issue.

 

The Korea Alliance of Patients' Organization and the Korea Psoriasis Association had raised the issue at its 'Patient Shouting Cafe' event held on the 18th.

 

Immediately after the event, the Ministry of Health and Welfare and the National Health Insurance Service held the roundtable and expressed their positions on improving the special exemption of insurance calculation for severe psoriasis.

 

A patient group has requested improvement of the registration criteria for the exempted calculation of health insurance for severe psoriasis that will be up for re-registration in one year to the government and payers.

 

Pic.

 

from the hosted by the Korea Alliance of Patients Organization

The point raised by KAPO was clear and simple.

 

Patients with severe psoriasis have to bear a very high cost of treatment that can only be relieved through the special exemption of insurance calculation.

 

However the entry criteria for the special calculation, the new and re-registration standards, are too strict, and only 17,500 out of the 22,000 severe psoriasis patients are unable to receive any benefit from the system.

 

In other words, for most patients, the benefit is just a 'pie in the sky.' As the re-registration of special exemption of insurance calculation for severe psoriasis will start next year, unless the system is improved now through discussions, the issue is doomed to reoccur.

 

However, the biggest barrier to the improvement is that the experts' opposition to making changes in the registration criteria.

 

In fact, at the National Assembly's Health and Welfare Committee plenary session on the 16th, Yong-ik Kim, president of NHIS had answered Rep.

 

Chun-sook Jeong's inquiry that as the payer, the organization had to follow the experts' judgment as its experts opposed to the change of new registration standards for special exemption of insurance calculation for severe psoriasis.

 

On this, the patient group emphasized that when setting registration standards for special exemption of insurance calculation, policy judgments should be made based on equity with other disease and social consensus rather than simply by reimbursement standards.

 

They argued that the special exemption system is different from medical insurance benefit standards that require consideration of cost-effectiveness and efficacy and that the government is hiding behind experts' judgment.

 

High-priced biologics for severe psoriasis are already being reimbursed.

 

However, contrary to other severe diseases like Crohn's disease, ankylosing spondylitis, and severe atopic dermatitis that apply special calculations immediately for high-priced biologics, the special calculation does not apply to severe psoriasis despite the reimbursement approved for its treatment.

 

The high out-of-pocket payment borne by the patients greatly affects the livelihood and life of the patients.

 

On this, the Korea Psoriasis Association, a direct stakeholder to the system, suggested that the NHIS transparently discuss this issue at the Special Exemption of Calculation Committee meeting, a discussion body for various stakeholders rather than blindly follow the judgment (medical judgment) made by the expert advisory committee.

 

MOHW's Insurance Benefits Division and the NHIS responded that they will address the issue of new registration standards of severe psoriasis in a proactive manner and identify and find solutions for the issue that was discussed at the meeting.