The prescription of choline alfoscerate-based drugs for dementia prevention has increased annually, although they have not been proven effective in preventing dementia, according to a lawmaker.
Rep. Nam In-soon of the Democratic Party of Korea said so Wednesday after analyzing relevant data from the Health Insurance Review and Assessment Service (HIRA).
According to the “Prescription Status of Choline Alfoscerate-Containing Drugs” submitted by HIRA to Rep. Nam, the number of prescriptions for choline alfoscerate-based drugs increased by 42.8 percent over the past three years, from 691.23 million in 2019 to 986.82 million in 2022.
Along with the increase in prescription volumes, the amount of prescriptions also increased by 40.3 percent in the three years, from 352.5 billion won ($263 million) in 2019 to 494.7 billion won in 2022. In the first half of this year, the prescription amount was 286.5 billion won and is expected to exceed 500 billion won by the end of the year.
According to the prescription status of choline alfoscerate-based drugs by indication, only 92.5 billion won worth, or 18.7 percent of the 494.7 billion in prescriptions for choline alfoscerate-based drugs last year, were related to dementia. The remaining 81.3 percent, worth 402.2 billion won, were prescribed for diseases other than dementia, which have not been proven effective.
A look at the top 20 drugs in health insurance claims last year also showed that a company’s choline-containing drug ranked sixth with a claim amount of 97.2 billion won, and another company's choline-containing drug ranked 12th with a claim amount of 75.5 billion won.
"The amount of choline alfoscerate-containing drugs prescribed for diseases other than dementia, which have not been proven effective in the five years from 2018 to last year, amounted to 1.6 trillion won," Rep. Nam said. "Even though choline alfoscerate-containing drugs have not been proven to prevent dementia, they are prescribed under the guise of dementia prevention drugs and brain nutrients. And the number of prescriptions is increasing yearly, eroding the health insurance finance and increasing patient burden."
For diseases other than dementia, the health authorities should actively curb prescriptions and utilize the savings to expand coverage for anticancer drugs, Nam added.
Meanwhile, the Health Insurance Policy Review Committee, based on its assessment of the appropriateness of benefits for choline alfoscerate-containing drugs, has decided to maintain health insurance coverage for dementia but increase patients’ out-of-pocket payment from 30 percent to 80 percent when these drugs are used for diseases other than dementia.
At the time, the Ministry of Health and Welfare said that although indications with unproven effectiveness should be limited in benefits, it applied selective benefits for diseases other than dementia, considering society’s needs.
Rep. Nam commented on it, saying, "Pharmaceutical companies filed a suit against the selective benefits, and an executive order was cited. The companies are taking advantage of the time limit until the main lawsuit ends."
Besides, the Ministry of Food and Drug Safety is pushing for the clinical reassessment of choline alfoscerate-containing drugs. Although the health insurance and pharmaceutical companies agreed to retrieve reimbursement if the clinical reassessment fails, Nam added that the reimbursement rate remains at only 20 percent.
"HIRA has chosen and managed choline alfoscerate-containing drugs as a target for screening and continuous management since 2022, but it is not enough as the total amount of claims and total claims are increasing yearly," she said. "It is necessary to properly inform the public about the efficacy and effectiveness of choline alfoscerate-containing drugs and actively curb prescriptions for diseases other than dementia by, for instance, disclosing hospitals and doctors that overprescribe them for diseases other than dementia."