From September, Heart Ultrasound Test Costs Cut to Less Than Half... Pancreatic Cancer Treatment Covered by National Health Insurance

[Asia Economy Reporter Seo So-jeong] From September, the cost of echocardiography will be reduced to less than half.

On the 23rd, the Ministry of Health and Welfare held the Health Insurance Policy Deliberation Committee (Gunjungshim), the highest decision-making body of health insurance, and approved the application of health insurance for echocardiography and the revision of the drug reimbursement price ceiling table.

Echocardiography is a test that evaluates the size and function of the heart, thickness of the heart wall, heart valves, ischemic heart disease, and other morphological structures and functions of the heart. The types of heart diseases covered are extensive, including coronary artery disease, valvular heart disease, heart failure, arrhythmia, and myocarditis/pericarditis.

Until now, echocardiography was only applied to the four major severe diseases (cancer, heart, cerebrovascular, rare incurable diseases), tuberculosis, and neonatal intensive care patients, mostly limited to the special calculation period (within 30 or 60 days after receiving heart-related surgery/procedure or being prescribed medication).

After this period, patients had to bear the full cost of the test, and since prices varied by medical institution, the patient burden was significant.

Therefore, from September, health insurance will be applied when there is a heart disease or suspicion thereof (once) and when observing the progress of related diseases (once a year).

However, for children under 19 years old, considering the high necessity of testing for congenital heart abnormalities, difficulty in self-reporting symptoms, the risk of missing the optimal treatment time if the number of tests is limited, and the low risk of misuse, no limit will be set on the number of tests.

Additionally, health insurance will be applied to high-risk groups requiring preoperative heart function checks, such as elderly diabetic patients scheduled for surgery.

With health insurance applied, the cost of transthoracic general ultrasound examination at tertiary hospitals, which previously averaged about 240,000 KRW as a non-reimbursed price, will be reduced to a patient burden of 29,720 KRW for inpatient and 89,100 KRW for outpatient after insurance application.

For transthoracic specialized ultrasound examinations, the average non-reimbursed price at tertiary hospitals exceeded 290,000 KRW, but after insurance application, the patient burden will be reduced to 43,340 KRW for inpatient and 130,000 KRW for outpatient.

At the meeting, the application of health insurance coverage and the price ceiling for 'Onyvide Injection,' a second-line treatment for metastatic pancreatic cancer, were also approved.

According to the evaluation by the Drug Reimbursement Evaluation Committee of the Health Insurance Review and Assessment Service and negotiations with the National Health Insurance Corporation, the ceiling price for Onyvide Injection was set at 672,320 KRW per vial (bottle). While the annual cost of Onyvide Injection treatment is about 8.14 million KRW without insurance, the patient burden will be reduced to about 410,000 KRW with health insurance coverage.

A Ministry of Health and Welfare official said, "With this decision, health insurance coverage for metastatic pancreatic cancer treatment drugs will be possible, improving access to new drug treatments and reducing patients' medical expenses." They added, "We plan to revise the 'Drug Reimbursement List and Reimbursement Price Ceiling Table' notification so that Onyvide Injection can be newly covered by health insurance starting next month on the 1st."

This content was produced with the assistance of AI translation services.