Is it better to remove prescription drug insurance benefits for bribery?

The Department of Health and Welfare’s Health Insurance Policy Review Committee is due to meet on Friday this week to consider whether to suspend reimbursement of drugs prescribed by doctors who have been given pots -of wine from pharmaceutical companies.

The upcoming decision is expected to affect various drugs, industry watchers said.

The government is due to decide this week whether or not to suspend reimbursement of drugs prescribed by doctors who have received kickbacks from drugmakers.

The Department of Health and Social Care had planned to rule 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 these drugs. Accordingly, the panelists deferred discussion to the next meeting.

At Friday’s meeting this week, panelists will discuss whether to suspend reimbursement for drugs for which illegal discounts have been found.

After an amendment to the National Health Insurance Act in May, the government is not suspending reimbursement for these drugs.

Still, the Department of Health and Welfare adheres to the principle that drugs prescribed in bribes before the law was revised should not be eligible for insurance benefits.

However, some legal experts have raised concerns about the ministry’s stance, saying suspending reimbursement for these drugs could harm patients’ interests and even be unconstitutional.

The Korea 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 of law firm HnL said that if the government were to suspend prescription drugs for corruption on a large scale, it could disrupt clinical care.

According to Park, the biggest problem with the suspension of this drug reimbursement is that it affects pharmaceutical companies, medical institutions and patients.

He said a doctor who has guided a patient to take the same drug for a long time based on medical judgments should explain why the drug should be changed for non-medical reasons.

If so, patients could lose trust in their prescribers and raise concerns and complaints about changes in prescription medications, Park said.

Some patients worry unnecessarily or mistakenly think that the doctor changed the medicine because they received bribes or the patient’s illness got worse.

“Some of them will complain to their doctors,” he added.

Earlier, in the repeated revisions of the National Health Insurance Law, the issue of suspension of drug reimbursement.

In 2018, when the Ministry of Government Legislation revised the National Health Insurance Act, it made clear that penalties against drug supplies for illegal discounts should not undermine patients’ right to access medications.

In another revision in 2021, the government raised the range of penalties imposed on the third detection of illegal reimbursements from 15% of the total amount of health insurance benefits to 50% to increase the effectiveness of penalties.

Park argued that the government should thoroughly consider whether suspending so many drugs due to illegal discounts would be the best choice and actively consider another measure that could replace suspending drug reimbursement.

According to Park, Section 99(2) of the National Health Insurance Act, prior to the revision, stated that if the Minister of Health and Welfare recognized “a particular reason”, such as a serious risk to public health, the suspension or exclusion of reimbursement may be replaced by a penalty insofar as it does not exceed 40% of the total amount of the health insurance benefit.

“Insisting on the suspension of drug reimbursement could lead to criticism that the Department of Health and Welfare does not consider confusion in clinical care and patient anxiety as a ‘special reason,'” a said Park.