Novartis’ ‘Cymria’, which has attracted attention as an ultra-expensive drug, Roche’s ‘Rozlitrec’ and Bayer’s ‘Vitrac B’ are listed as payrolls one after another.
The upper limit of Kimria is set at 390,039,359 won. The patient has to pay 598 million won. For diffuse large B-cell lymphoma, a refund contract was signed based on performance at 6 months and 12 months.
The Health Insurance Policy Review Committee decided to apply the new drug’s benefit at its meeting on the 31st.
Rosley Trek and Vitrakbi, which received product approvals with a difference of one month, will receive salaries side by side from the 1st of next month.
The oncogenic fusion of the neurotrophic tyrosine receptor kinase (NTRK) gene, a disease for which these drugs are used, is expressed in 0.3 to 1.0% of all solid cancer patients.
Patients with NTRK fusion have a poorer prognosis than patients without the genetic mutation, and have a shorter life expectancy due to a higher rate of brain metastasis compared to other genetic mutations.
As a result of reviewing the contents of the main committee by Hit News, the need for insurance coverage was recognized for the two drugs in the last cancer disease review committee because the proportion of patients showing NTRK fusion was very low and there were no alternative drugs with the same therapeutic position. Clinical usefulness and cost-effectiveness have also been proven.
Rosley Trekis listed in 4 countries including the US, UK, Germany, and Japan among the A7 countries, and the pharmaceutical company has signed a contract to refund a certain percentage of the drug claim amount and a certain percentage of the excess of the expected total amount (cap) to the National Health Insurance Corporation.
The upper limit of Rozli Trek is 39,027 won/100mg and 78,082 won/200mg. Estimated demand is 70 billion won.
Vitrak Bis listed in the United States, Japan, France, Germany, and the United Kingdom, and the upper limit is set at 386-KRW/25mg Vitrak B capsule, 12342 KRW/100mg, and 24,068 KRW/ml Vitrak-B. Estimated demand is 70 billion won.
Patient Burden Relief Cases
Kymriaju (self-customized one-shot treatment)
In case of non-reimbursement, the cost of one-time medication is approximately KRW 400 million → One-time medication cost is reduced to a maximum of KRW 5.98 million (applied by the health insurance self-pay cap system) due to the application of health insurance
Rosley Trek Capsules
In case of non-reimbursement, the annual medication cost is approximately KRW 85 million → The annual medication cost is reduced to approximately KRW 4.3 million (5% of the co-pay applied by the patient) due to the application of health insurance
Vitrak B Capsule / Liquid
In case of non-reimbursement, the annual medication cost is approximately KRW 88 million → The annual medication cost is reduced to approximately KRW 4.4 million (5% of the patient’s own expenses) due to the application of health insurance
It is a treatment for B-cell acute lymphoblastic leukemia (ALL) and diffuse large B-cell lymphoma (DLBCL). Kymriaalso enters the salary range.
It has been a year since I started the payroll registration process through the permit-evaluation linkage system in March last year.
As Kymria is an expensive, one-time treatment, a high level of financial sharing was required for uncertainty.
Therefore, for DLBCL, which has inferior clinical performance compared to ALL, a performance-based payment risk-sharing system was applied according to patient-level treatment outcomes. The disease progression (PFS, progression-free survival) was subdivided into 6 months and 12 months after administration and differential refund rates were set.
However, it was decided not to implement the pre-approval system because the medication could be delayed and the patient’s condition could be serious.
In consideration of foreign drug prices and financial influence, the upper limit was set at 390,039,359 won/pack, and the estimated amount of claim is about 71 billion won.
