고가 의약품 건강보험 급여 현황 분석

Patterns of National Health Insurance Spendings for High-Priced Medicine in Korea

In recent years, the introduction of high-priced innovative pharmaceuticals has been on the rise, placing a burden on the national pharmaceutical expenditure. This study aimed to analyze the spending trends of high-priced drugs in South Korea over the past ten years and derive policy implications for the management of pharmaceutical expenditure. The claims data of National Health Insurance (NHI) were used as the data source, and drugs with annual per-patient costs exceeding ten million KRW were defined as 'high-priced drugs.' The study selected the each year’s list of high-priced drugs from 2010 to 2021 and analyzed the trends considering their spending size, manufacturer types, therapeutic groups, Risk-Sharing Agreements, and Economic Evaluation Exemption. The spending on high-priced drugs accounted for 8.0% of the NHI pharmaceutical expenditure in 2021, and it has been increasing annually by 14.3% since 2010. The expenditure on high-priced drugs introduced through the RSA (Risk-Sharing Agreement) rapidly increased, especially for oncology drugs and immunosuppressants. This study defined high-priced drugs based on per-patient costs and observed the trends in the expenditure of these drugs according to pharmaceutical characteristics. Based on this, it is significant in proposing issues and policy implications for noteworthy drug categories.