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The Health Insurance Review and Assessment Service (HIRA) has been analyzing how new reimbursements for antidiabetic combination therapies mixing oral SGLT-2 and DPP-4 inhibitors would affect the national health insurance financing.
If the national health insurance covers SGLT-2 inhibitors in combination with DPP-4 inhibitors, which are used for a broad diabetic population, it will significantly increase government spending on health insurance.
Kim Ae-ryun, director-general of the Pharmaceuticals Benefits Department at HIRA, said that the health insurance agency reviewed the criteria for reimbursing the combination of SGLT-2 inhibitors and DPP-4 inhibitors among oral diabetes treatments.
“Now, we are analyzing the reimbursement’s fiscal impact,” she told reporters on Tuesday.
More specifically, the government is reviewing reimbursement for three-drug combo, metformin+SGLT-2 inhibitor+DPP-4 inhibitor, another three-drug combo metformin+SGLT-2 inhibitor+thiazolidinediones(TZD), and two-drug combo mixing some of the SGLT-2 inhibitors with sulfonylurea or insulin.
Only some SGLT-2 inhibitors are eligible for reimbursement review because the HIRA excluded drugs that the Ministry of Food and Drug Safety banned to use in combo with other medicines.
In response to criticism that the HIRA’s review was too slow, Kim said HIRA would complete the evaluation on the drug combos within the legally-set assessment period of 150 days.
HIRA is also speeding up the re-evaluation of the medicines’ eligibility for the national health insurance coverage.
After HIRA noticed the plan for re-evaluation in March, it requested pharmaceutical companies of reimbursable drugs to submit related data for re-assessment. All 141 drug companies have completed data submission, HIRA said.
This year, HIRA will re-evaluate six agents for health insurance benefits — streptokinase/streptodornase, almagate, sodium alginate, eperisone hydrochloride, tiropramide hydrochloride, and adenine combo. HIRA chose the six considering reimbursement cases overseas and local insurance claims.
“We are reviewing each ingredient’s clinical usefulness at the working level and through expert advisory meetings,” Kim said. “We will deliberate it at an evaluation subcommittee and the pharmaceutical benefit review committee within the third quarter.”
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