[Reporter’s View] Improving NHI-related legislation

to eliminate the harmful effects of reimbursement suspension administrative dispositions

The bill to remove the administrative drug price cut and reimbursement suspension dispositions that were imposed on illegal drug rebates from the current National Health Insurance Act and raising the penalty surcharge system has drawn industry attention and rose as an issue of focus this year.

 

The bill aims to minimize third-party damage inflicted on patients, prescribing doctors, and dispensing pharmacists by the administrative dispositions imposed on rebate drugs, and to strengthen control over illegal rebates.

 

The controversy over the irrationality of the drug price cuts and reimbursement suspension dispositions imposed on rebate drugs had been an issue for quite some time.

 

The law was revised to improve the irrationality of reimbursement suspensions, where doctors and patients were left with no choice but to use more expensive drugs or experience other disadvantages in treating their diseases due to the reimbursement suspension dispositions.

 

After the reimbursement suspension system on rebate drugs was implemented in July 2014, the revised National Health Insurance Act that applies drug price cuts according to the number of rebates and suspends reimbursement or imposes fines after 3 violations took effect in March 2018.

 

The bill that proposed the reform of the National Health Insurance Act was submitted by NA Rep.

 

Min-Suk Kim of the Democratic Party of Korea as representative.

 

The bill attempts to improve the institutional irrationality of the current reimbursement suspension system.

 

For this, the proposed bill not only contains measures that remove the price cut and suspension of reimbursement dispositions on rebate drugs and improve the standard for fines, but provisions to resolve the issue of drugs that have received reimbursement suspensions in the past.

 

The supplementary provision of the proposed bill allows the law to be applied to drugs that received drug price cuts or reimbursement suspension dispositions or are undergoing administrative litigation at the time Rep.

 

Kim’s bill was implemented.

 

If so, it will be possible to retroactively apply the new system to drugs that were fined when the previous reimbursement suspension system was applied, reducing the risk of unreasonable cases and improving patient rights.

 

The National Health Insurance Service agreed with Kim’s proposed bill that replaces reimbursement suspensions with fines.

 

The NHIS said, “The reimbursement suspensions may violate the health rights of patients in need of the drug, so the NHIS agrees on the purpose of the amendment to impose a fine instead,” acknowledging the harm caused by the reimbursement suspension disposition.

 

Although Kim’s bill cannot be completely flawless., the bill shows traces of multifaceted considerations made to improve the issue of the reimbursement suspension system as rationally as possible while strengthening control over rebates.

 

Lee’s bill to revise the National Health Insurance Act is soon set to be reviewed by the Ministry of Health and Welfare soon.

 

It is hoped that the efforts of the pharmaceutical industry and the National Assembly, which have been struggling to address the issue of reimbursement suspension for a decade, will be thoroughly reflected in the legislation during the review.

 

Also, the legislation, which can allow three birds - preventing unnecessary damage to patients, doctors, and pharmacists, minimizing waste of health insurance finances, and strengthening punitive fines for rebates on pharmaceutical companies - to be caught with one stone, will be successfully implemented.