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From January 2014 to 2020 Korea paid for most of the cancer and rare-disease medicines it listed through confidential risk-sharing contracts, almost all of them simple financial deals rather than payment for results.
A policy analysis using Kingdon's three-streams model, with descriptive analysis of Korean listings and comparison with four other countries. Managed entry agreements were introduced in January 2014 as part of a benefit-enhancement plan for four major diseases and were then extended as a route to cover new premium-priced medicines. Between January 2014 and December 2020, 48 medicines were contracted under them, 73.4 per cent of listed medicines for cancer or rare diseases; 97.9 per cent of contracts were finance-based and outcome-based contracts such as coverage with evidence development were 2.1 per cent. Agreement between Korea's use of these contracts and that of the United Kingdom, Italy and Australia was low (kappa 0.00 to 0.14).
The listed price of a new cancer drug in Korea is often not the price the insurer pays: the difference sits in a confidential contract. That has made more drugs available, but it means the public cannot see what is being paid or whether the drug delivered what was promised.
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