College of Pharmacy, Chung-Ang University, Seoul 06974, Korea.
Department of Pharmaceutical Engineering, Hoseo University, Asan 31499, Korea.
Int J Environ Res Public Health. 2019 Jan 21;16(2):288. doi: 10.3390/ijerph16020288.
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.
本研究回顾和评估了国家药物处方集系统，该系统通过对新纳入韩国国家健康保险系统的药品进行报销决策，以改善患者获得新药的机会。国家健康保险利用三种方法来提高患者获得昂贵药物的机会：风险分担协议、指定基本药物和免除成本效益分析。患者希望快速处理新药的报销，以改善他们获得这些药物的机会，而支付者则对将其列入考虑之列持谨慎态度，因为这涉及到相关的财务负担和成本效益的不确定性。然而，制药公司主张将药品价格定在一定阈值以上，以维持全球定价策略，覆盖药物开发成本，并为未来的研发投资提供资金。韩国政府有望制定改善对有未满足需求的药物的患者获得药物的政策，以扩大健康保险覆盖范围。同时，有必要设计上市后的管理方法，以有效管理国家健康保险系统的财务资源。
