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Policy
Government unconvinced of pre-listing reimbursement
by Kim, Jung-Ju Oct 20, 2020 09:16am
The South Korean government has technically expressed its opposing stance at a National Assembly audit session questioning about the necessity of adopting the ‘pre-listing reimbursement and post-evaluation system’ that exempts a deliberation on reimbursement feasibility to enhance a severe-case patient’s treatment access. Considering the drug coverage enhancement process has been fast regardless of new drugs’ pricing surging, the government views focusing on listing speed would rather risk the pricing management or post-management, which could lead to worsening financial management. The Ministry of Health and Welfare (MOHW) submitted a statement with the said answer for the National Assembly Health and Welfare Committee audit. The written answer is an extension to the MOHW National Assembly audit convened for two days on Oct. 7 and 8. According to the material MOHW provided to Lawmaker Jeon Bongmin, the government is still in process of enhancing the National Health Insurance (NHI) coverage centering cancer and severe disease treatments. Compared to 2016, the government has spent 25 percent more on pharmaceutical expense in 2019. And the expense spent on anticancer treatment during the same time almost doubled to 59 percent. The overall pharmaceutical expense has surged from 15.4 trillion won in 2016 to 19.3 trillion won in 2019. From August 2017 to the base year, total 58 items have been listed and the expense was increased by 1.6 trillion won originally from 1 trillion won. Some argue the ‘pre-listing reimbursement and post-evaluation system’ should be introduced to limited subject to improve the treatment access even further. Regarding the issue, Lawmaker Lee Jongseong questioned the ministry if the pre-listing reimbursement and post-evaluation system is needed as an alternative listing system for severe and rare disease treatments. But in the end, MOHW rejected the suggestion. MOHW official said, “The pre-listing reimbursement would make drug pricing adjustment difficult when the company refuses to accept the evaluation result, and it could also weaken the National Health Insurance Service’ (NHIS) negotiation power,” so “The issue needs to be reviewed thoroughly as we foresee the difficulties in practical system operation and reasonable pharmaceutical expense management.” However, the ministry added other regulations and systems currently in effect are contributing in the enhancement of the treatment access. MOHW official answered, “The Ministry of Food and Drug Safety (MFDS) has been operating the ‘approval-evaluation linkage system’ that conducts a reimbursement feasibility evaluation on rare disease treatment prior to their approval. And also the ministry is actively seeking means to shorten the overall listing review duration with pharmacoeconomic evaluation exemption system and shortened drug pricing negotiation.”