Patient Accessibility and Budget Impact of Orphan Drugs in South Korea: Long-Term and Real-World Data Analysis (2007-2019)

Abstract

This study aimed to identify orphan drug accessibility and impact on pharmaceutical budgets in South Korea by analyzing the status of orphan drug designation, approval, reimbursement, and pharmaceutical expenditure. We analyzed the dataset on orphan drugs designated, approved, and reimbursed from 2007 to 2019 based on long-term real-world data. The designated and approved orphan drugs were 165 and 156, respectively, and 88 out of 156 approved products were reimbursed. Total expenditure on orphan drugs increased annually to account for about 1.44% of total pharmaceutical expenditure in 2018. Orphan drug expenditure per patient increased on average by 8.7% per year. The average annual cost of orphan drugs was USD 27,000-USD 47,000, with the maximum value of USD 260,000-USD 560,000. As there are a number of orphan drugs that have not yet been reimbursable after approval, a reimbursement policy should be established that considers the characteristics of orphan drugs. Since the rapid increase in orphan drug expenditure can be a potential threat to the insurance budget, budget management should also be considered. In conclusion, it is necessary to take preemptive measures to manage the health insurance budget efficiently while improving patient accessibility to orphan drugs.

Keywords: Orphan drug; budget controls; budget impact; health services accessibility; patient accessibility; pharmaceutical expenditure; rare disease; reimbursement.

Figure 1

Trend of orphan drug (OD) expenditure ratio out of total pharma expenditure (2010–2018). The expenditure ratio on ODs gradually increased and accounted for about 1.44% out of total pharmaceutical expenditure in 2018. Source: Korea National Health Insurance Service, Health Insurance Claims Data.