The Ministry of Health and Welfare’s Health Insurance Policy Review Committee is scheduled to hold a meeting on Friday this week to determine whether to suspend reimbursement for medicines prescribed by doctors who received bribes from pharmaceutical companies.
The upcoming decision is expected to affect various medications, industry watchers said.
The health and welfare ministry had planned to decide on the matter in April.
However, at a meeting on Tuesday, some members of the insurance policy review committee argued that the government should be more careful about discontinuing insurance benefits for such drugs. As a result, the panelists postponed the discussion to the next meeting.
At the meeting on Friday this week, the panelists will discuss whether it would be appropriate to suspend reimbursement for drugs for which illegal rebates were found.
After an amendment in the National Health Insurance Act in May, the government does not suspend reimbursement for such drugs.
Still, the health and welfare ministry adheres to the principle that drugs prescribed in bribery before the law revision should not be able to get insurance benefits.
However, some legal experts raised concerns about the ministry’s stance, saying the suspension of reimbursement for those drugs could infringe on patient interests and be even unconstitutional.
The Korean Society of Law and Medicine held a forum on the unconstitutionality of drug reimbursement suspension on April 16.
At the forum, pharmacist-turned-lawyer Park Seong-min at HnL Law Firm said if the government suspends drugs prescribed in bribery on a large scale, it could confuse clinical care.
According to Park, the biggest problem with the suspension of such drug reimbursement is that it affects pharmaceutical firms, medical institutions, and patients.
He said that a doctor who guided a patient to take the same medication for a long time based on medical judgments would have to explain why the medication has to be changed for non-medical reasons.
In this case, patients could lose trust in their prescribers and raise concerns and complaints about changes in prescription drugs, Park argued.
Some patients worry unnecessarily or wrongly think the doctor changed the drug because they received kickbacks or the patient’s disease worsened.
“Some of them will complain to their doctors,” he added.
Earlier, in repeated revisions of the National Health Insurance Act, the issue of drug reimbursement suspension.
In 2018 when the Ministry of Government Legislation revised the National Health Insurance Act, it made it clear that sanctions against drug supplies for illegal rebates should not infringe patients’ right to access drugs.
In another revision in 2021, the government raised the range of penalties imposed on the third detection of illegal rebates from 15 percent of the total amount of health insurance benefits to 50 percent to increase the effectiveness of the sanctions.
Park argued that the government should thoroughly review whether suspending so many drugs because of illegal rebates would be the best choice and actively consider another measure that can replace drug reimbursement suspension.
According to Park, the Article 99 Paragraph 2 of the National Health Insurance Act, before the revision, stated that if the Minister of Health and Welfare recognizes “a special reason,” such as a serious risk to public health, the reimbursement suspension or exclusion may be replaced with a penalty to the extent that does not exceed 40 percent of the total amount of health insurance benefit.
“Insisting on drug reimbursement suspension could lead to criticism that the health and welfare ministry does not view confusion in clinical care and patient anxiety as a ‘special reason,’” Park said.