Improving Patient Access to New Drugs in South Korea: Evaluation of the National Drug Formulary System.

Seung-Lai Yoo,Jong Lee,Seung-Mi Lee,Won-Gu Kang,Dong-Churl Suh,Dae-Jung Kim,Sang-Yoon Kim

doi:10.3390/ijerph16020288

Abstract

This study reviews and evaluates the national drug formulary system used to improve patient access to new drugs by making reimbursement decisions for new drugs as part of the South Korean national health insurance system. The national health insurance utilizes three methods for improving patient access to costly drugs: risk-sharing agreements, designation of essential drugs, and a waiver of cost-effectiveness analysis. Patients want reimbursement for new drugs to be processed quickly to improve their access to these drugs, whereas payers are careful about listing them given the associated financial burden and the uncertainty in cost-effectiveness. However, pharmaceutical companies are advocating for drug prices above certain thresholds to maintain global pricing strategies, cover the costs of drug development, and fund future investments into research and development. The South Korean government is expected to develop policies that will improve patient access to drugs with unmet needs for broadening health insurance coverage. Simultaneously, the designing of post-listing management methods is warranted for effectively managing the financial resources of the national health insurance system.

Highlights

Numerous countries have begun prioritizing cost-effectiveness when assessing new medical technologies to more effectively allocate limited health resources given the rising public sector costs associated with an aging population, increased prevalence of patients with chronic diseases, and the introduction of costly new drugs [1,2,3]
Evidence-based evaluation is often difficult for costly new drugs with low demand and no alternatives
They claim that very few new anticancer drugs are listed under the South Korean health insurance system as compared to the health insurance systems of other advanced countries which makes access to new drugs more difficult

Summary

Introduction

Numerous countries have begun prioritizing cost-effectiveness when assessing new medical technologies to more effectively allocate limited health resources given the rising public sector costs associated with an aging population, increased prevalence of patients with chronic diseases, and the introduction of costly new drugs [1,2,3]. Evidence-based evaluation is often difficult for costly new drugs with low demand and no alternatives (this is evident for anticancer drugs and drugs for rare diseases). Listing new drugs under the public health insurance system without evaluating them can be criticized as a waste of financial resources, whereas designating the drugs as non-reimbursable can lower patient access to them [7,8].

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Discussion

Conclusion