The Health Insurance Review & Assessment Service (HIRA) determined that Eli Lilly and Company's diabetes and obesity drug "Mounjaro (ingredient name tirzepatide)" has sufficient value for health insurance coverage when used as an adjunct therapy for diabetes.
According to HIRA on the 4th, the Drug Reimbursement Evaluation Committee (Drug Evaluation Committee) that met that day decided that Mounjaro meets the criteria for reimbursement as an adjunct to diet and exercise therapy to improve glycemic control in adults with type 2 diabetes.
The Drug Evaluation Committee is the first mandatory gate that all non-oncology new drugs must pass to enter the health insurance system. Only after passing this stage can they begin price negotiations with the National Health Insurance Service.
By passing this evaluation, Mounjaro secured the possibility of entering reimbursement. Barring major variables in the price negotiation process, insurance benefits are expected to be available in the first half of next year when used in combination with other diabetes medications.
At the same meeting, in addition to Mounjaro, the committee also found that AbbVie's lymphoma treatment "Epkinly," Samo Pharmaceutical's pediatric achondroplasia treatment "Voxzogo," and Switzerland's Medison Pharma's polyneuropathy treatment "Amvuttra" have reimbursement appropriateness.
On the other hand, Janssen, a subsidiary of Johnson & Johnson (J&J), saw its pulmonary arterial hypertension treatment "Opsynvi," and Japan's Mitsubishi Tanabe Pharma's anemia treatment "Vadanem," deemed eligible for reimbursement discussions only if prices are reduced to the levels proposed by the committee.
Meanwhile, Dong-A ST's "Stillen" (mugwort extract), which was on the brink of being pushed out of the reimbursement market, was evaluated to have reimbursement appropriateness if it meets cost-effectiveness. This means it can remain listed for insurance if it accepts the lower price proposed by HIRA. The same condition was applied to the chronic renal failure uremia treatment "spherical activated carbon."