Disallowing cross-dosing of severe atopic dermatitis drugs comes under parliamentary scrutiny

The unreasonable treatment environment for people with severe atopic dermatitis, in which patients must take their first-choice medication even if it has side effects or is ineffective, not to give up their insurance benefits or the special exemption system, has finally gotten on the block of the parliamentary audit.

Rep. Jeon Jin-sook of the opposition Democratic Party of Korea (DPK) called in Park Jo-eun, head of the Severe Atopic Dermatitis Association (SADA), as a testifier at the National Assembly’s audit of the Ministry of Health and Welfare on Tuesday to examine the treatment environment for people with severe atopic dermatitis.

On Sept. 21, Rep. Jeon also held a policy discussion titled “How to Improve the Treatment Environment for Severe Atopic Dermatitis' jointly with the association to commemorate World Atopic Dermatitis Day.

“The voices of the patients I heard during the World Atopic Dermatitis Day debate were so heartbreaking and memorable that I decided to call them as references for the parliamentary audit of the administration,” Jeon said in her opening speech.

Park, the head of SADA, said, “Severe atopic dermatitis is an incurable skin disease that is not just an itchy skin. It is very itchy, painful, oozing, and bleeding to the point where daily life is impossible. Many people who have met me recently said that I did not look like a patient. However, I was in a situation where I could not go outside the house due to severe itching and oozing before the treatment.”

“With the health insurance coverage and special exception for severe atopic dermatitis, medications that used to cost more than 1 million won ($740) are now available for around 70,000 won,” Park continued. “However, although the number of drugs covered by health insurance has increased to six, patients cannot switch to another drug. This is because the government does not provide health insurance and special calculation exceptions for switching drugs.”

Noting that all drugs have different prices and different effects, Park said, “You can only know which one will work for you by trying it. However, patients have to pay for up to 17 million won for drugs per year if they switch to another drug, so even if new drugs are released, the only drug that patients can use is the one they chose in the first place.”

If they want to change the drug, even if it has severe side effects or is ineffective, they have to stop treatment and worsen their condition to meet the criteria for benefits and special calculation from the beginning, Park pointed out.

According to Park, some of the patients in the patient group cannot move their necks due to hardened pus in the joints that fold, including the neck, arms, and legs. This makes it difficult to eat, so they eat porridge through a straw. Some go blind due to cataracts and retinal detachment.

“However, even patients who complain of these side effects would not choose to return to that painful time to cross-dose drugs,” Park said.

Park noted that patients with psoriasis, a skin condition similar to severe atopic dermatitis, can switch to a different drug when it doesn't work or has side effects.

“From the patient's point of view, it doesn't make sense that they have to keep using a drug that doesn't work or has side effects,” Park said. She lamented, saying, “It's hard to understand why it should be possible for similar skin diseases but impossible for severe atopic dermatitis.”

“At the policy debate in September, an official from the Health Insurance Review and Assessment Service (HIRA) said there should be data to verify the safety and effectiveness of switching drugs. However, there were cases where switching diseases was allowed without such data. Above all, I would like to ask who the data is for.” Park said. “There are many patients suffering from inadequate treatment even now, and it is frustrating that we have to wait for the data to be created and verified.”

Rep. Jeon also told Minister of Health and Welfare Cho Kyoo-hong about the hardships patients experience.

“The suffering of patients is indescribable. In a situation where they should focus on the disease, they seem to be suffering too much from other problems,” Jeon said. “What do you think of the cross-dosing of medications so that patients with severe atopic dermatitis can use the right medication at the right time?”

Minister Cho replied positively, saying, “I didn't understand why cross-dosing in atopic dermatitis was a problem but realized that it is a very important issue. I think the evidence is accumulating now. I was told that the HIRA will actively review it.”