- Date2025-02-11
Publication of Review Result of the 8th Serious Illness (Cancer) Review Committee of 2024
□ The Health Insurance Review and Assessment Service (President Kang Jung-Gu) releases the results of the deliberations of the 8th Cancer Review Committee in 2024 on ‘Reimbursement criteria for drugs used for cancer patients(Improvement of reimbursement standards reflection clinical reality)’ as follows.
○ New pharmaceutical(application for determination of health insurance coverage) and expansion of reimbursement standards
|
Category |
product |
Pharmaceutical company |
Efficacy and effectiveness |
Deliberation results |
|
Application for Healthcare Benefit Reimbursement |
Tecvayli Inj (Teclistamab) |
Janssen Korea, Inc |
Monotherapy for adult patients with relapsed or refractory multiple myeloma who have received at least three lines of treatment, including proteasome inhibitors, immunomodulatory agents, and anti-CD38 monoclonal antibodies |
To be discussed again |
|
Imjudo Inj (Tremelimumab) |
AstraZeneca Korea, Inc |
Combination therapy with durvalumab as first-line treatment for adult patients with advanced or unresectable hepatocellular carcinoma |
Reimbursement criteria to be established | |
|
Expand reimbursement scope |
Tagrisso Tab (Osimertinib) |
AstraZeneca Korea, Inc |
Combination therapy with pemetrexed and platinum-based chemotherapy as first-line treatment for patients with locally advanced or metastatic non-squamous non-small cell lung cancer with EGFR exon 19 deletion or exon 21 (L858R) substitution mutations. |
To be discussed again |
|
Imfinzi Inj (Durvalumab) |
AstraZeneca Korea, Inc |
Combination therapy with gemcitabine and cisplatin as first-line treatment for patients with locally advanced or metastatic biliary tract cancer. |
Reimbursement criteria to be established | |
|
Bencord Inj (Bendamustine Hydrochloride) + Mabthera Inj (Rituximab) |
Boryung Inc, Roche Inc |
Combination therapy with bendamustine and rituximab for patients with mantle cell lymphoma (MCL). |
Reimbursement criteria to be established |
○ Improvement of reimbursement standards reflecting clinical reality
- The Health Insurance Review and Assessment Service (HIRA) has been continuously reviewing and evaluating the improvement requests from medical societies such as the Korean Medical Association and the Korean Hospital Association since December 2023. This time, the following items were reviewed.
|
Key recommendations |
Deliberation results |
|
Improvement of the phrase 'failed chemotherapy including docetaxel' for prostate cancer chemotherapy eligibility |
Acceptance of the recommendation |
|
Re-administration of platinum-based chemotherapy for platinum-resistant gynecological cancer patients |
Maintain the current |
|
Regarding the administration of adjuvant therapy during or after surgery and the subsequent use of palliative therapy in case of recurrence/metastasis |
Acceptance of the recommendation |
|
* Pursuant to Article 5 and Article 5.2 of the Rules on the Criteria for National Health Insurance Reimbursement, the President of the Health Insurance Review and Assessment Service may notify the details of the reimbursement criteria and methods for drugs prescribed and administered to seriously ill patients that are designated and notified by the Minister of Health and Welfare after deliberation by the Serious Illness Review Committee. The reimbursement criteria for such drugs may be set differently according to clinical literature, domestic and foreign guidelines, and expert opinions within the scope of efficacy and effectiveness of the Ministry of Food and Drug Safety approval, and the reimbursement decision and criteria may change in the course of subsequent process. |
