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The re-evaluation of the reimbursement appropriateness of hyaluronic acid (HA) eye drops has ultimately been delayed.

On the 7th, the Health Insurance Review and Assessment Service (HIRA)’s Drug Reimbursement Committee decided to conduct an additional review of the re-evaluation item. Similarly, on the 20th, the Ministry of Health and Welfare (MOHW)’s Health Insurance Policy Review Committee was unable to reach a decision.

Experts who reviewed the re-evaluation item expressed concerns about the potential impact of limiting the amount of HA eye drops use on other single-use eye drops. As the re-evaluation process goes back to the beginning, it will take some time for the results to be determined.

On the 20th, the Drug Reimbursement Committee stated during a meeting that, "Regarding HA eye drops, the evaluation results have indicated that establishing a comprehensive reimbursement criteria on single-use eye drops may be necessary, considering the transition to alternative single use eye drops. We will soon make a final decision on this matter."

Initially, based on the initial evaluation report by the Drug Reimbursement Committee in September, HA eye drops were deemed unsuitable for reimbursement for conditions related to exogenous factors, such as post-surgery use, medication-related issues, trauma, and contact lens wear.

On the other hand, endogenous conditions like Sjogren's syndrome, Stevens-Johnson syndrome, and dry eye syndrome were found to be appropriate for reimbursement. Yet, it was deemed necessary to establish reimbursement criteria, including restrictions such as limiting prescriptions to one per patient visit and setting an annual prescription limit per patient, to ensure appropriate usage.

Considering that endogenous diseases make up more than 80% of all prescriptions, pharmaceutical companies were somewhat relieved by the outcomes of the initial review. In fact, no objections were raised by pharmaceutical companies in response to the initial results.

However, there is concern about limiting the volume of use. Pharmaceutical companies have expressed concern about discussions to limit the amount of annual use to four from the current 60 annual uses, as it would reduce the track record by half.

Despite these concerns, it is reported that no objections were filed as the re-evaluation results were not too bad. Additionally, revising the reimbursement criteria to limit the amount of use may not be straightforward due to opposing opinions among experts. In fact, some experts have suggested that the review of limiting the amount of use should be withdrawn.

With the October parliamentary audit season season, there was a surge of concerns about weakened access for senior patients and potential for higher costs, creating an unfriendly atmosphere towards the HIRA. Despite HIRA's efforts to dispute media reports suggesting a more than tenfold increase in the cost of non-reimbursed drugs, there was an ongoing anxiety among the public.

During the parliamentary audit season, there was a strong call from members of opposition party to maintain the reimbursement for HA, and the HIRA seemed preoccupied with appeasing the members.

Amidst these developments, there were rumors circulating before the final decision in December that reimbursement might be retained for post-LASIK surgery and other exogenous conditions. This proposal would represent a reversal from the initial review. In these circumstances, it’s reported that consultations with experts regarding limiting the amount of usage have not advanced.

Experts voiced concerns about a potential balloon effect after the Drug Evaluation Committee's final evaluation. They anticipated that limiting the amount of use of HA eye drops might increase volume of usage of other single-use eye drops. As a result, there is a prevailing opinion that a review of reimbursement criteria for all single-use eye drops should be conducted.

However, it is perceived that if the committee were to review the reimbursement criteria for all single-use eye drops, including HA eye drops, it could be challenging to reaching a conclusion in a short time.

"Revising the reimbursement criteria for all single use eye drops would pose challenges in terms of time and gathering expert opinions. Consequently, it is possible that the re-evaluation of HA eye drops may not reach a conclusion," said a representative from the pharmaceutical company. It appears that the HA eye drop companies, which had entered into preemptive contracts with prominent law firms at significant cost, have seen their desires fulfilled.