Starting Next Month, 'Rutateraju' Covered by National Health Insurance... Patient Burden Reduced to 4.4 Million Won

Josapatajeong, Reshinowonju, etc. Covered by Health Insurance
COVID-19 Health Insurance Fees Also Improved

[Asia Economy Reporter Ki Ha-young] The high-cost anticancer drug 'Lutathera' will be covered by health insurance starting next month, reducing the annual patient burden to about 4.4 million KRW.

According to the Ministry of Health and Welfare on the 26th, the 5th Health Insurance Policy Deliberation Committee meeting of 2022 was held the previous day, where it was decided whether three drugs (seven items) including Lutathera, Josapata tablets, and Resinone injections would be covered by health insurance and their reimbursement ceiling prices. Accordingly, these drugs will newly receive health insurance coverage starting next month.

Lutathera, an injection for treating gastrointestinal and pancreatic neuroendocrine tumors, is known as a high-cost drug costing about 100 million KRW per four treatment cycles. At this meeting, the ceiling price (expected claim amount) was set at 22,104,660 KRW per vial (50 mg). While the annual medication cost for Lutathera was about 89 million KRW when not covered by insurance, applying health insurance is expected to reduce the annual patient burden to about 4.4 million KRW (applying a 5% co-payment).

The ceiling price for Josapata tablets, a treatment for acute myeloid leukemia, was set at 214,100 KRW per tablet (40 mg). The Ministry of Health and Welfare explained that the medication cost for Josapata tablets, which was about 45 million KRW annually without insurance, will decrease to about 2.2 million KRW (applying a 5% co-payment).

The ceiling price for five items including Resinone injections (a 4:1 w/w mixed gel of divinyl sulfone cross-linked sodium hyaluronate gel and sodium hyaluronate solution) was set at 41,800 KRW per ampoule (2 ml), reducing the annual medication cost from about 80,000 KRW to about 20,000 KRW (applying a 30% co-payment).

The Health Insurance Policy Deliberation Committee also decided to expand the insurance coverage of the immuno-oncology drug 'Keytruda' from the existing 'second-line treatment for non-small cell lung cancer' to 'first-line treatment' and to apply insurance benefits for 'relapsed or refractory classical Hodgkin lymphoma.' Accordingly, starting from the 1st of next month, about 4,000 patients with metastatic non-small cell lung cancer and Hodgkin lymphoma will additionally receive health insurance coverage, and the treatment cost, which previously cost about 100 million KRW annually without insurance, is expected to decrease to about 3.5 million KRW.

Since April this year, the fee for neonatologist specialists dedicated to neonatal intensive care units has been restructured to reduce the number of newborns per specialist, allowing for more intensive care. The committee decided to expand the additional fee categories for dedicated neonatologists in neonatal intensive care units from two to four and to make working standards more flexible.

Currently, when one specialist cares for fewer than 10 newborns, the fee is 42,980 KRW; for 10 to fewer than 20 newborns, it is 21,490,000 KRW. Going forward, if fewer than 5 newborns are cared for, the fee will be 120,350 KRW; for 5 to fewer than 6.5 newborns, 94,560 KRW; for 6.5 to fewer than 10 newborns, 55,870 KRW; and for 10 to fewer than 20 newborns, 25,790 KRW.

Also, while all dedicated specialists currently must work more than 40 hours per week, going forward, if there are two or more dedicated specialists, all except one may work 20 hours per week, and in such cases, they will be counted as 0.5 of a specialist.

The committee also decided to adjust the reimbursement fee for root canal treatment of C-shaped root canal teeth, which are more complex and difficult to treat than regular teeth, in May. This is expected to expand natural tooth preservation treatments and alleviate the financial burden on health insurance caused by the increase in implant treatments.

In response to the spread of Omicron, health insurance fees related to COVID-19 were also improved. The coverage criteria for rapid antigen tests were expanded, and fees for telephone consultations and prescriptions for general management groups under home treatment were established. For home-treated patients requiring face-to-face care, fees for outpatient treatment centers and antibody treatment visit fees for elderly nursing home patients under cohort isolation were newly introduced. Fees for operating room isolation management for surgeries involving confirmed patients requiring anesthesia and deliveries of confirmed patients, as well as isolation room hospitalization fees supporting home-treated patients needing hemodialysis, were also established.

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