The national health insurance benefit for breast cancer is expected to expand.
The Health Insurance Review & Assessment Service will prepare a revision for ‘details on the criteria and methods for applying insurance benefit to drug prescribedㆍadministered to cancer patients,’ and collect related opinions by Wednesday, 28th. There are new standards for three types of chemotherapy.
In the revision, a new standard was established for the use of Novartis’ Kisqali in breast cancer patients.
Kisqali is a drug for advanced or metastatic breast cancer that is HR-positive and HER2-negative and was approved in South Korea in October last year. It has a mechanism to suppress Protein Kinase, an enzyme that catalyzes the phosphorylation of proteins.
The newly established insurance benefits are for ▲Kisqali + Letrozole ▲Kisqali + Anastrozole ▲Kisqali + Fulvestrant.
Among these, for ‘Kisqali + Letrozole’ and ‘Kisqali + Ansatrozole,’ which gained insurance benefit as the first treatment, the national health insurance benefit will be applied for metastatic and recurrent breast cancer patients who satisfy all three conditions: ‘HER2-negative’, ‘HR-positive,’ and ‘have not previously been administered nonsteroidal aromatase inhibitor.’
However, if a nonsteroidal aromatase inhibitor is used as preoperative chemotherapy or postoperative adjuvant therapy, the reimbursement will be applied for relapses one year after the end of an administration.
At the second stage of administration, premenopausal women, who fail chemotherapy, are reimbursable. In this case, they should be administered Goserelin or Leuprolide at intervals of four weeks.
The combination therapy of ‘Kisqali’ and AstraZeneca’s ‘Fulvestrant (Faslodex Inj.)’ was directed to provide insurance benefits during the second stage of administration.
This chemotherapy will be recognized as the national health insurance benefit for metastatic and recurrent breast cancer patients after menopausal when these are met: ‘HER2-negative’, ‘HR-positive,’ if the patients have not previously been administered a CDK4/6 inhibitor or Fulvestrant’, and ‘if it has progressed after the previous endocrine therapy (if it has progressed during or within a month after the conventional treatment or during or within one year after the postoperative adjuvant therapy).
The Health Insurance Review & Assessment Service plans to implement it on November 1st (Sunday) after collecting opinions on the revision.