In July, generic drugs for epilepsy and treatments for dry eye will newly enter the national health insurance coverage, reducing patients' out-of-pocket costs.
By contrast, a new migraine drug that has been sold without insurance coverage will end domestic supply at the end of the year, showing a contrasting picture in which generics enter coverage while some new drugs exit the domestic market during the same period.
◇ In July, epilepsy and dry eye treatments enter coverage
According to the pharmaceutical industry on the 29th, the Health Insurance Policy Deliberation Committee recently finalized the listing of 99 items for national health insurance through a written resolution, including seven companies' brivaracetam generics for epilepsy and 30 items including new drugs that went through price negotiations or negotiation waivers.
Brivaracetam is used as an add-on therapy for patients 16 and older with partial-onset seizures whose seizures are not adequately controlled with existing antiepileptic treatments.
This coverage applies to a total of 29 brivaracetam generic items approved for seven companies—Chong Kun Dang pharmaceutical, Daewoong Pharmaceutical, Bukwang Pharmaceutical, Samjin Pharmaceutical, Myung In Pharm, Whan In Pharm, and Hyundai Pharm. The maximum reimbursable prices by strength were set at 10 mg 256 won, 25 mg 513 won, 50 mg 770 won, 75 mg 963 won, and 100 mg 1,155 won.
Brivaracetam's insurance price benchmark was set based on an assessment that the average daily treatment cost of existing epilepsy treatments is about 1,713 won. Under the national health insurance system, if a pharmaceutical company accepts a price below this benchmark, the drug can be listed for coverage without separate price negotiations.
With seven companies accepting maximum prices at or below the benchmark, the drugs will be covered starting in July without price negotiations with the National Health Insurance Service. Accordingly, a total of 29 items are included on the reimbursement list.
The expected annual claim amount is about 6.5 billion won, and the number of patients is estimated at about 11,564. The annual medication cost per patient is about 562,100 won, and with insurance coverage, the patient copay is expected to fall to about 168,630 won.
Unimed Pharmaceutical's dry eye treatment "Sysfol eye drops" met reimbursement criteria and will be covered without negotiations with the National Health Insurance Service after its price was adjusted compared with existing treatments.
As a result, the annual medication cost per patient is expected to be about 37,000 won, and with insurance coverage (30% copay), the out-of-pocket cost will fall to about 11,000 won. The annual patient population is estimated at about 54,000, and the fiscal burden on national health insurance is expected to be about 2 billion won.
◇ Noncovered migraine drug "Reyvow" to end supply at year-end
Meanwhile, Ildong Pharmaceutical's domestically supplied new migraine drug "Reyvow (lasmiditan)" will end sales in Korea at the end of this year.
Ildong Pharmaceutical said it was recently notified by original developer Eli Lilly and Company of a decision to halt global production and supply of Reyvow. The company noted the decision was a business strategy based on changes in the global migraine treatment landscape and the expansion of alternative therapies, not due to safety or quality issues.
Reyvow was developed as an acute migraine treatment that, unlike triptans, does not cause vasoconstriction and can be used in patients with cardiovascular disease.
However, during the 2022 drug benefit evaluation for national health insurance, an assessment price using existing triptans as comparators was presented, but it was not accepted, halting the listing process, and the drug was subsequently launched as a noncovered medicine.
Entering the domestic market without coverage meant patients had to pay the full price, which may have acted as a constraint on prescription expansion.
Meanwhile, the industry also interprets that treatment conditions are changing as drugs in the same class and alternative migraine treatments have recently entered insurance coverage.
A pharmaceutical industry official said, "Whether a drug is listed for national health insurance—in other words, whether it enters coverage—affects not only patient access but also the medicine's competitiveness in the domestic market."