선택약가제도가 건강보험 약품비 지출에 미치는 영향: 경구용 당뇨병 치료제를 대상으로 한 시나리오 분석
The Effect of Tiered Copayment System on Pharmacy Benefit Expenditure of National Health Insurance in Korea: Scenario Analysis based on the Use of Oral Antidiabetic Medications
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Purpose: This study was aimed to examine the financial effect of 2-tiered copayment system on annual expenditure ofpharmacy benefit in the National Health Insurance (NHI) of Korea, focusing on oral antidiabetic medications. Methods:284 oral antidiabetic products with 14 different active single ingredients listed in the National Formulary of NHI (August2009) were assigned to tier 1 or tier 2 according to the selected criteria. 10 different combinations of coinsurance rateswere selected to estimate the changes in drug expenditure cost of NHI. Results: The annual drug cost was estimated basedon the drug price per unit listed in the National Formulary and the used amount of products in 2009 from the IMS Healthdata of Korea. In the combinations of coinsurance rate of 20% for tier 1 and 40% for tier 2, the total annual drug cost wasestimated to be reduced by 1.3% in the case of no change of generic and original drug consumptions, and to be reducedby 4.3% in the case of 10% increased generic drug consumptions. Conclusion: The tiered copayment system with optimalcoinsurance rates appears to be a potential strategy to reduce the financial burden of NHI in Korea by promoting theuse of generic products.
Abstract
Purpose: This study was aimed to examine the financial effect of 2-tiered copayment system on annual expenditure ofpharmacy benefit in the National Health Insurance (NHI) of Korea, focusing on oral antidiabetic medications. Methods:284 oral antidiabetic products with 14 different active single ingredients listed in the National Formulary of NHI (August2009) were assigned to tier 1 or tier 2 according to the selected criteria. 10 different combinations of coinsurance rateswere selected to estimate the changes in drug expenditure cost of NHI. Results: The annual drug cost was estimated basedon the drug price per unit listed in the National Formulary and the used amount of products in 2009 from the IMS Healthdata of Korea. In the combinations of coinsurance rate of 20% for tier 1 and 40% for tier 2, the total annual drug cost wasestimated to be reduced by 1.3% in the case of no change of generic and original drug consumptions, and to be reducedby 4.3% in the case of 10% increased generic drug consumptions. Conclusion: The tiered copayment system with optimalcoinsurance rates appears to be a potential strategy to reduce the financial burden of NHI in Korea by promoting theuse of generic products.
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