Addressing unprofitable products and ensuring appropriate revision of functional categories

Committee:
Medical Equipment
status:
Some progress
Published:
In the FY2026 revision, the assessment of difficulty of substitution for unprofitable product measures was revised to take into account the number of suppliers and market share. However, product-level repricing for unprofitable products has not been fully realized. In addition, there was no progress on the request to allow reimbursement prices exceeding the pre-subdivision price to be set when functional categories are subdivided.

Recommendations

  • Establish criteria that enable appropriate assessment of the difficulty of substituting necessary products, taking into account differentiated clinical use and the spare supply capacity of other companies.
  • Where a price revision for an entire functional category is difficult, allow repricing limited to the products that have become unprofitable.