Different Rxing patterns for premium-priced therapies in China and South Korea

In China, a combination of government restrictions on reimbursement and regional variations in formulary coverage heavily influence the use of premium-priced targeted therapies in the breast cancer drug market.

Decision Resources’ new Emerging Markets Physician & Payer Forum report, titled Breast Cancer in China and South Korea: Physician and Payer Insight into Market Access Drivers, also finds that, in South Korea - where drug coverage is widespread - national treatment guidelines are used by payers to inform appropriate reimbursement and are strictly monitored and enforced. South Korean payers express concerns about the future escalating cost of treatments for breast cancer, particularly the combination of premium-priced agents, despite their potential efficacy benefits.

According to interviewed payers in China, the large patient population size prevents breast cancer agents with a high price tag from achieving inclusion on the national formulary. While some regional formularies can choose to reimburse premium-priced therapies, they only cover a proportion of treatment costs, placing significant financial burden on patients.

Contrasting market barriers

“The barriers to market access in China and South Korea are contrasting,” said Decision Resources’ principal analyst Amy Duval, noting that, “in China, premium-priced agents are not covered on national formularies as the budgets cannot accommodate the number of patients who would be eligible for treatment.”

In South Korea, however, said Ms Duval: “High cost agents for breast cancer have typically been admitted for reimbursement, although there is strict monitoring of how they are prescribed, and increasing cost pressures on payers mean that this monitoring is likely to become even more intense. Getting the payer value messaging right, so that the product is optimally positioned in terms of the specifics of NHI reimbursement, will be increasingly important in the future.”