Comparison of major Asian Countries’ Reimbursement Mechanisms for Innovative Pharmaceutical Products
Asia is home to 57% of the world’s population and accounts for around 40% of the world’s pharmaceutical market. It is one of the most challenging pharmaceutical markets due to its disorganised nature. It continues to grow due to increasing populations, market size, ageing populations, and illnesses.
The challenges related to the health technology assessment (HTA), which determines reimbursement pricing, differ from country to country in Asia and are in a nascent stage unlike in most of the developed European countries. For instance, high- and upper-middle-income countries use the HTA to guide reimbursement and coverage decisions. Asia comprises a number of lower-income countries that use the HTA for planning and budgeting purposes.
Most Asian countries do not use pharmacoeconomic evaluations or head-to-head comparison models for setting reimbursement prices for drugs; instead, they rely on external reference pricing and internal price benchmarking for tendering and negotiating prices. Some countries use bridged versions — for example, South Korea also uses QALY/ICER evaluations, and Japan uses cost-plus pricing and a price maintenance premium to determine the prices of innovative drugs. With the level of challenges, updates and complexities in Asian reimbursement models, it is important to understand the differences in the HTA models of these countries. In this paper, we attempt to provide a comparison of the HTA reimbursement mechanisms and decisions to increase clarity.
For granular details of reimbursement mechanisms in these countries, please refer to the respective links below:
Japan’s reimbursement mechanism for innovative pharmaceutical products
China’s reimbursement mechanism for innovative pharmaceutical products
South Korea’s reimbursement mechanism for innovative pharmaceutical products
Abbreviations:
QALY — Quality-adjusted life year
ICER — Incremental cost-effectiveness ratio
NHSA — National Healthcare Security Administration
NDRC — National Development and Reform Commission
MOHRSS — Ministry of Human Resources and Social Security
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NHI — National Health Insurance
Chuikyo — Central Social Insurance Medical Council
MHLW — Ministry of Health, Labour and Welfare
HIRA — Health Insurance Review Agency
DBCAC — Drug Benefit Coverage Assessment Committee
DREC — Drug Reimbursement Evaluation Committee
PE — Pharmacoeconomic
WAP — Weighted average price
CE — Cost-effectiveness
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