Atopic Dermatitis Cross-Switching Expected by Q1

Reimbursement for switching between JAK inhibitors and biologics in treating atopic dermatitis is expected to gain approval within the first quarter. However, transitioning within the same drug class will remain excluded from coverage.

According to industry sources, the Health Insurance Review and Assessment Service (HIRA) convened a Drug Reimbursement Evaluation Committee on January 9 to discuss expanding reimbursement criteria. The committee decided to approve coverage for cross-switching between JAK inhibitors and biologics.

The next steps include notifying pharmaceutical companies of the decision. Once companies agree, drug pricing will be adjusted according to pre-established price reduction schedules, followed by formal notification and implementation of the updated reimbursement guidelines.

Currently, patients with severe atopic dermatitis who experience adverse effects or inadequate efficacy from JAK inhibitors or biologics face significant barriers when attempting to switch treatments. Insurance coverage requires patients to complete three months of first-line therapy and achieve an EASI (Eczema Area and Severity Index) score of 23 or higher, criteria that many view as overly restrictive.

These requirements have drawn criticism for effectively forcing patients to endure worsened symptoms before accessing alternative therapies. Both patients and medical professionals have consistently pushed for less stringent criteria. At a press briefing in May 2024, Professor Ji-Young Ahn of the National Medical Center’s Dermatology Department emphasized the unmet need for cross-treatment switching and the burdensome reimbursement process.

In response, HIRA and the Ministry of Health and Welfare (MOHW) initiated a review of the reimbursement criteria in 2024. This included consultations with academic societies on current treatment practices, evidence supporting cross-treatment switching, comparative efficacy data, cost-effectiveness analyses, and patient selection guidelines based on real-world clinical conditions. Financial implications were also assessed as part of the review.

Following this comprehensive evaluation, the committee reached a consensus this month to move forward with expanded reimbursement, paving the way for accelerated implementation.

Currently approved treatments for atopic dermatitis include JAK inhibitors such as AbbVie’s Rinvoq (upadacitinib), Eli Lilly’s Olumiant (baricitinib), and Pfizer’s Cibinqo (abrocitinib), alongside biologics like Sanofi’s Dupixent (dupilumab) and Leo Pharma’s Adtralza (tralokinumab). Among these, Rinvoq, noted for its significant financial impact, is likely to undergo a price reduction.

The policy shift marks a significant step in addressing long-standing concerns and improving access to effective therapies for patients with severe atopic dermatitis.