Aging Population Drives Rise in Chronic and Rare Diseases... Health Insurance Drug Expenses Reach 26 Trillion Won Annually

Pharmaceutical Expenses Paid by Health Insurance Exceed 26 Trillion Won Annually
Driven by Expanded Coverage for Cancer and Rare Disease Treatments
Proportion of Pharmaceutical Costs Within Medical Expenses Rises to 23.6%
Patients in Their 60s Account for the Largest Share of Drug Expenditures
Chronic Disease Medications, Including Hyperlipidemia Treatments, Top Spending List

As chronic diseases increase due to population aging and more cancer and rare disease treatments covered by health insurance, the pharmaceutical expenses paid by health insurance have exceeded 26 trillion won annually.

According to the expenditure status of reimbursed pharmaceuticals analyzed by the National Health Insurance Service on the 16th, the total pharmaceutical expenses in 2023 amounted to 26.1966 trillion won, an 8.5% increase compared to the previous year (24.1542 trillion won). This growth rate is about twice as high as the 4.7% increase in total medical expenses in 2023 (110.8029 trillion won) compared to the previous year, and the proportion of pharmaceutical expenses within medical expenses also rose by 0.8 percentage points to 23.6%.

In accordance with the National Health Insurance Comprehensive Plan, the government is expanding health insurance coverage for cancer and rare disease treatments that impose a heavy burden on drug costs, and is promoting drug reimbursement by comprehensively considering social and clinical demands, cost-effectiveness, public acceptance, and financial conditions for essential medicines required for treatment. In 2023, 24 drugs including Evrysdi, a treatment for spinal muscular atrophy, were reimbursed, and the usage scope of 8 drugs including treatments for severe atopic dermatitis was expanded.

As a result of continuously expanding reimbursement for essential medicines directly related to the lives of the people, the out-of-pocket expenses for patients with cancer or rare incurable diseases decreased, while the reimbursed pharmaceutical expenses used for their treatment increased by 10.8% and 9.7% respectively in 2023, reaching 3.8402 trillion won and 2.5492 trillion won, surpassing the overall pharmaceutical expense growth rate of 8.5%.

By age group, pharmaceutical expenses for patients in their 60s accounted for the largest share at 6.6 trillion won (25.2%), followed by 5.2 trillion won for those in their 70s, 4.4 trillion won for those in their 50s, and 3.1 trillion won for those in their 80s. The proportion of pharmaceutical expenses for those aged 60 and above was 58.1% of the total.

By healthcare institution, pharmacy claims were the highest at 18 trillion won (68.9%), followed by tertiary general hospitals (3.8 trillion won), general hospitals (2.2 trillion won), and clinics (1.1 trillion won).

By efficacy, atherosclerosis agents (hyperlipidemia treatments) had the largest expenditure at 2.849 trillion won, followed by antineoplastic agents (2.7336 trillion won), antihypertensive agents (2 trillion won), peptic ulcer agents (1.3904 trillion won), and antidiabetic agents (1.3667 trillion won).

The National Health Insurance Service explained, "Due to population aging and westernized dietary habits, hyperlipidemia treatments have recently ranked first in annual expenditures, and chronic disease treatments including hypertension, diabetes, and hyperlipidemia occupy the top ranks."

By ingredient, the combination drug 'Ezetimibe + Rosuvastatin,' which corresponds to the top efficacy group atherosclerosis agents, was ranked first with expenditures of 605.8 billion won, followed by Choline Alfoscerate (cognitive enhancer, 563 billion won), Atorvastatin (hyperlipidemia drug, 558.7 billion won), Clopidogrel (antithrombotic agent, 417.9 billion won), and Rosuvastatin (hyperlipidemia drug, 337.7 billion won). Notably, the choline agent ranked second saw its expenditure increase by 104.3% over the past five years, from 275.6 billion won in 2018 to 563 billion won in 2023, prompting the Ministry of Food and Drug Safety to conduct a clinical re-evaluation through clinical trials to verify its therapeutic effects.

An official from the National Health Insurance Service stated, "Pharmaceutical expenses continue to rise due to the listing and expanded criteria for high-cost anticancer drugs and gene therapies, as well as the increase in chronic diseases caused by population aging. We will enhance coverage to ensure that citizens can timely access necessary medicines for treatment, while establishing management measures for medicines that are overused or unnecessarily prescribed."

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