Reimbursement of Biologics has Improved in South Korea as Evidence of TNF-alpha Inhibitor Efficacy Has Grown, Although Patient Copayments Remain a Barrier to Uptake, According to a New Report from Decision Resources
September 24, 2012-Burlington, Mass. – Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds that currently, in both China and South Korea, less than one-third of surveyed clinicians’ patients who are eligible for a biological therapy are actually receiving one for Crohn’s disease (CD) or ulcerative colitis (UC). Johnson & Johnson’s Remicade is the only biological agent currently approved for the treatment of CD in China, while no biologics are approved there to treat UC. In South Korea, Remicade and Abbott/Eisai’s Humira are approved for CD, with Remicade being the only biologic treatment available in for UC. Additionally, the first biosimilar version of Remicade—Celltrion’s Remsima—was approved in South Korea earlier this year for several indications, including CD and UC.
The new Emerging Markets Physician & Payer Forum report entitled Positioning of Current Biologics for Crohn’s Disease and Ulcerative Colitis: Physician and Payer Insight into Market Access Drivers in China and South Korea also finds that unaffordable copay is the top factor limiting prescriptions of biological therapies in both China and South Korea. Lack of reimbursement from state health insurance is also cited as a key barrier by Chinese physicians. In China, Remicade is not included in the current NRDL (National Reimbursement Drugs List) although it is included in select PRDLs (Provincial Reimbursement Drugs List), and, currently, one year treatment of CD with Remicade costs around $14,000 (in U.S. dollars) which is more than three times the average income per capita. In South Korea, while 90 percent of the cost of approved biologics is reimbursed, patient copay for one year treatment with Remicade amounts to about six percent of the average income in the country. Interviewed payers in South Korea point out, however, that reimbursement of biologics has improved as evidence of TNF-α inhibitor efficacy has been built up.
Interviewed payers in China believe that Remicade and Humira pose a significant burden on China’s healthcare budget and that it is unlikely either of these agents will be included in the next version of the NRDL, expected to publish in 2013. They also indicate that Remicade is only prescribed in large or specialized hospitals while clinicians at lower-tier hospitals, especially those in underdeveloped areas, know little about the product.
“Interviewed payers believe that there is little popular demand for the reimbursement of Remicade, but they believe that as physicians become more aware of the benefits of biological therapies and increase their use, the reimbursement/coverage for this class will improve,” said Decision Resources Director Janie Cox, Ph.D. “In South Korea, although 90 percent reimbursed, CD and UC biologics must be prescribed in accordance with government guidelines in order to qualify for reimbursement. Payers report that, as a result of their rigidity, the national prescribing guidelines prevent necessary drug prescription in some cases as clinically eligible patients may not qualify for national reimbursement. These payers add, however, that increasing prevalence of CD and UC will lead to an increase in the use of CD and UC therapies and may help further loosen government reimbursement restrictions on CD and UC therapies.”
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