[2020 National Audit] Dementia Drugs Costing 350 Billion Won Annually in Health Insurance Benefits, Dementia Patients Account for Only 17%

Nam In-soon "Disguising as Dementia Prevention and Brain Supplements, Draining Health Insurance Finances"

Nam In-soon, Democratic Party of Korea lawmaker

[Asia Economy Reporter Choi Dae-yeol] It has been found that only about 17% of prescriptions for cholin alfoscerate, which has sparked controversy over its effectiveness for diseases other than dementia, were actually prescribed to dementia patients. Despite the lack of proven efficacy, there have been suspicions since the past that it was promoted as having dementia prevention effects or as a brain nutrient supplement, leading to concerns about serious financial leakage in the National Health Insurance (NHI) system.

According to data disclosed on the 19th, submitted by the Ministry of Health and Welfare and the Health Insurance Review & Assessment Service (HIRA) to Nam In-soon, a member of the National Assembly’s Health and Welfare Committee from the Democratic Party, the prescription amount for cholin alfoscerate last year was 352.5 billion KRW, with approximately 1.85 million patients. Among them, patients prescribed for severe dementia or dementia-related diseases were 326,000, with NHI claims amounting to about 60.3 billion KRW. This accounts for only 17.1% of the total claims amount for medicines containing cholin alfoscerate.

This drug was found to lack clinical usefulness evidence for diseases other than dementia-related conditions in the re-evaluation of reimbursement appropriateness, leading to a change from full reimbursement to selective reimbursement, with plans to re-evaluate after three years. Selective reimbursement is applied when economic feasibility or treatment effectiveness is uncertain and additional evidence is needed for verification. After the transition to selective reimbursement, the pharmaceutical company mainly opposed this, filed lawsuits, and the court issued a suspension order.

Rep. Nam said, "While clinical usefulness evidence exists for dementia-related diseases, there is no evidence to recognize usefulness for other diseases," adding, "It is appropriate to exclude NHI reimbursement for diseases other than dementia, but to prevent confusion in the field due to sudden adjustments, an 80% patient co-payment selective reimbursement was applied, with plans to re-evaluate selective reimbursement after three years."

According to data submitted by HIRA, prescriptions were frequently made for brain metabolism-related diseases or other conditions such as depression, not dementia. Prescriptions for about 700,000 patients with mild cognitive impairment amounted to 117 billion KRW in NHI claims. Prescriptions for emotional and behavioral changes, senile pseudo-depression, and others involved about 87,000 patients, with claims reaching 39.5 billion KRW. This means that more than 8 out of 10 prescriptions are made clinically without clear evidence.

By type of medical institution, clinics accounted for over half at 52%, and large hospitals (general and tertiary) accounted for about 38% of prescriptions. Rep. Nam pointed out, "Except for patients diagnosed with severe dementia or dementia, there is no clinical usefulness evidence, but there have been suspicions that pharmaceutical companies promoted it to clinic-level medical institutions as a 'brain nutrient' or 'dementia prevention drug.'"

He continued, "Not only did the pharmaceutical company neglect to secure clinical evidence, but it also filed lawsuits against the decision of the Health Insurance Policy Deliberation Committee, which was established as a social consensus body, raising moral issues," adding, "Applying selective reimbursement to save NHI resources may hinder plans to expand reimbursement for cancer or rare and intractable diseases."

This content was produced with the assistance of AI translation services.