Abstract
Since 2007, South Korea has been a leading country in Asia in health technology assessment (HTA). In March 2026, a 100-day listing pathway using international reference pricing (IRP) without pre-reimbursement HTA was introduced for rare disease drugs, with plans to expand to all new drugs. This policy represents a fundamental shift from ex-ante to ex-post value assessment, de-prioritizing the cost-effectiveness analysis framework established in 2007. Given the lessons from IRP, the global movement toward value-based pricing, and Korea's current financial challenges, it is essential to develop a system that leverages the accumulated knowledge on HTA over the past two decades to balance expedited access with rigorous value assessment. Therefore, further specified post-evaluation mechanisms incorporating value for money principles are needed to avoid undermining value assessment and diverging from the global trend toward strengthening value-based healthcare.