[Asia Economy Reporter Lee Chun-hee] Starting next month, a penalty system will be implemented to prevent patients from suffering due to the pharmaceutical rebate 'Three Strikes Out' rule.
The Ministry of Health and Welfare announced on the 30th that the partial amendment to the Enforcement Decree of the National Health Insurance Act, which includes this content, was approved at the Cabinet meeting on the same day.
Currently, under the Pharmaceutical Affairs Act, for drugs found to have engaged in providing economic benefits (rebates) to medical institutions by pharmaceutical suppliers, the upper limit of medical benefits is reduced by up to 20%. If reoffended within five years, the reduction increases to a maximum of 40%, and if reoffended again within five years, the application of medical benefits is suspended, implementing the so-called 'Three Strikes Out' rule.
However, there have been concerns that patients taking drugs without alternative medicines may experience inconvenience. Accordingly, under the amendment to the National Health Insurance Act, which will take effect from the 9th of next month, instead of suspending the application of medical benefits, a penalty of up to 60% of the total annual medical benefit cost can be imposed. If reoffended within five years, the penalty can be increased up to 350%.
This amendment to the enforcement decree, in line with the legal revision, specifies the subjects and rates of penalties in cases where suspending benefits due to rebates is expected to cause public welfare issues such as inconvenience in taking medicines, allowing penalties to replace benefit suspension.
The subjects of penalties are drugs for which medical benefit suspension was ordered in the year of the order and the previous year, and the penalty rates are set between a minimum of 37% and a maximum of 340%, depending on the suspension period (within one year) and the number of violations. The penalty amount is calculated by multiplying the total review decision amount of the drug in the year before the suspension by the penalty rate. This provision will be enforced immediately upon promulgation on the 9th of next month, coinciding with the enforcement date of the amended law.
In addition to this, the amendment includes changes to the health insurance premium rates and improvements to the administrative disposition standards for medical institutions. According to the decision of the Health Insurance Policy Deliberation Committee in August, the health insurance rate for workplace subscribers next year will be raised from 6.86% to 6.99%, and the amount per point for regional subscribers will increase from 201.5 won to 205.3 won, a 1.89% increase compared to this year.
Also, the minimum average monthly amount subject to administrative disposition for medical institutions has been relaxed from 200,000 won to 400,000 won, and the minimum improper rate has been strengthened from 0.5% or more to 0.1% or more to enhance fairness among medical institutions.
Although the changes to the health insurance premium rates and the improvements to the administrative disposition standards for medical institutions will be promulgated on the 9th of next month, their enforcement is scheduled for January 1 of next year.
Choi Jong-gyun, Director of the Health Insurance Policy Bureau at the Ministry of Health and Welfare, said, "Through this amendment to the enforcement decree, specific criteria have been established to impose penalties instead of suspending drug benefits when it is expected to cause inconvenience to patient treatment or harm public welfare," adding, "We expect this to contribute to the improvement of the National Health Insurance system."
© The Asia Business Daily(www.asiae.co.kr). All rights reserved.
