Flexible pricing contracts drive apparent surge in prescription sales

June prescriptions of Fexuclue rise twofold from May…Envlo prescriptions rise fivefold

June rollout of flexible pricing contracts creates illusion in prescription data through higher list prices

Prescription sale data of several homegrown new drugs, including Fexuclue (fexuprazan), a P-CAB treatment for gastroesophageal reflux disease (GERD), and Envlo (enavogliflozin), an SGLT-2 inhibitor for diabetes, appeared to soar by as much as sixfold within a single month. Industry observers, however, analyzed that the spike is just an optical illusion that reflects the introduction of Korea's new flexible drug pricing contract system, rather than an explosive increase in actual prescriptions.

Fexuclue sales double to KRW 15.1 billion, Envlo jumps nearly sixfold

According to the market research institution UBIST on the 7th, Daewoong Pharmaceutical's Fexuclue recorded KRW 15.1 billion in prescription sales in June, up 115% year over year from June last year (KRW 7.0 billion) and 113% month over month from May (KRW 7.1 billion).

Since July 2024, Fexuclu had consistently generated monthly prescription sales of around KRW 7–8 billion. However, its June figure more than doubled.

Prescription sales of Daewoong Pharmaceutical's SGLT-2 inhibitor Envlo rose even more sharply. After posting steady monthly sales of KRW 900 million to KRW 1.1 billion, Envlo recorded KRW 5.3 billion in June alone, roughly equivalent to its combined prescription sales over the previous 5 months.

Monthly prescriptions of Fexuclue (top) and Envlo (bottom) (Unit: KRW 100 million, Source: UBIST)

Similar trends were also observed with products containing the same active ingredient as Fexuclue. Daewoong Bio's GERD treatment Wecab generated KRW 1.9 billion in June prescription sales, up 214% year-on-year and 93% from the previous month.

HanAll Biopharma's ‘Abcito,’ which had consistently posted KRW 200–300 million in monthly prescription sales, reached KRW 600 million in June. IN Therapeutics' ‘Velox Cab’ also nearly doubled its monthly prescription sales.

Flexible pricing scheme behind the apparent surge…an optical illusion rising due to the raised list price

Industry observers note that all 5 products were included in the government's flexible drug pricing scheme. The government recently introduced the scheme as part of broader drug pricing reforms. Under the system, a product's list price and actual transaction price can differ. The policy aims to improve patient access to innovative medicines while strengthening the global competitiveness of homegrown new drugs.

The first project included 12 products from eight companies. Korean products selected were Fexuclue, Envlo, Wecab, Abcito, and Velox Cab. Daewoong Pharmaceutical adopted the flexible pricing scheme to strengthen competitiveness while expanding exports to Latin America, India, and other overseas markets. For Envlo, the strategy was adopted to preserve export pricing while competing globally against products such as Forxiga (dapagliflozin) and Jardiance (empagliflozin).

Industry sources estimate that Fexuclue's list price roughly doubled, while Envlo's list price increased about fivefold. Fexuclue's list price was determined based on the highest adjusted A8-country price of its comparable drug ‘Vocinti (vonoprazan).’ Under the flexible pricing scheme, list prices are generally set within the highest adjusted price among the A8 countries (the United States, United Kingdom, Germany, France, Italy, Switzerland, Japan, and Canada). For homegrown new drugs that are not yet listed in A8 countries, comparable products are used as reference.

Among multinational pharmaceutical products, ‘Xtandi (Astellas Korea),’ ‘Pergoveris (Merck),’ ‘Faslodex (AstraZeneca Korea),’ and ‘Skyrizi (AbbVie Korea)’ have also been included in the scheme. However, because these products account for very little outpatient prescribing, the impact was not significant in UBIST prescription data.

More products are expected to adopt the flexible pricing track. Beginning in July, ‘Rinvoq (AbbVie Korea),’ ‘Xultophy (Novo Nordisk Korea),’ and ‘Scemblix (Novartis Korea)’ were additionally included. Also, drugs in the same class as Fexuclue, ‘K-CAB (tegoprazan, HK Inno.N),’ and ‘Vocinti (vonoprazan, Takeda Pharmaceuticals Korea)’ are being discussed as candidates.  ‘Jaqbo (zastaprazan, Onconic Therapeutics)’ is also a potential candidate.

However, pharmaceutical distributors and pharmacies say the monthly addition of new products to the scheme is creating significant administrative confusion. Although the government allows paperwork-based returns to reduce administrative burdens, settlement procedures for price differences remain complicated, and reimbursement timelines vary, resulting in a growing workload for frontline stakeholders.