약가인하 집행정지 의약품에 대한 분석 (환수·환급 제도의 시행 전후 비교)

Analysis of Price Reduction Execution Suspension Products (Before and After the Implementation of the Settlement System)

BACKGROUND This study aimed to analyze the status of price reduction execution suspension products before and after the settlement system’s implementation in November 2023. The policy was introduced to prevent abuse of execution suspension applications and reduce inefficiencies in price control. METHODS Data was collected from the Health Insurance Review & Assessment Service and the Ministry of Health and Welfare on products filing for execution suspension after price reduction orders. The reimbursement status analysis covered a three-year period from November 2021 to October 2024, with November 2023 as the key point for the system’s implementation. Product numbers, therapeutic classes, and suspension durations were compared. Additionally, price differences between reduced and suspended prices were analyzed from January 2020 to October 2024 based on original orders. RESULTS Following the settlement system’s implementation, the number of products under execution suspension declined by 21% by 2024. However, many products still experienced prolonged delays in price reduction, with the average suspension duration reaching 26.77 months. CONCLUSION While the system reduced the overall number of suspensions, challenges remain with long-term cases. Continuous monitoring and balanced policies are needed to improve the system’s effectiveness and ensure pricing stability.