"Outdated Coverage Criteria Hinder Diabetes Treatment... Patient Characteristics and Comorbidities Must Be Considered"

Korean Diabetes Association Points Out Restrictions on the Use of "GLP-1 Drugs" Such as Ozempic

Severe Type 2 Diabetes Patients Should Also Be Included in the "Home Care Support Program"

Although "Ozempic" and other glucagon-like peptide-1 (GLP-1) receptor agonists have become eligible for health insurance coverage as diabetes treatments, concerns have been raised that the criteria are excessively stringent, making it difficult to apply them to actual patients. Experts argue that improvements are needed in both drug selection options and coverage criteria to enable personalized treatment based on each patient's disease severity and comorbidities.

At a press conference held on the 24th at CenterPoint in Gwanghwamun, Seoul, Kim Jonghwa, the insurance director of the Korean Diabetes Association, explained the health insurance reimbursement criteria for GLP-1 receptor agonists. Korean Diabetes Association

The Korean Diabetes Association held a press conference on the 24th at Center Point in Gwanghwamun, Seoul, calling for the rationalization of coverage for GLP-1 receptor agonists and the introduction of a specialized management system for severe diabetes.

The association criticized the current insurance coverage criteria for GLP-1 receptor agonists, which have emerged as a core treatment for diabetes, stating that they are significantly out of step with the latest clinical guidelines. Currently, in Korea, coverage is only granted in cases where hemoglobin A1c (HbA1c) remains at 7.0% or higher after the use of metformin. However, the administrative process, such as the requirement to submit past medication records, is so complex that there are numerous practical limitations in prescribing these drugs to patients.

Kim Joungho, insurance director of the association and chief of endocrinology at Bucheon Sejong Hospital, explained, "Although insurance coverage for GLP-1 drugs began in February, the conditions are excessively strict, such as the mandatory use of sulfonylureas after metformin. This is completely inconsistent with the latest domestic and international clinical guidelines, which recommend prioritizing GLP-1 receptor agonists or sodium-glucose cotransporter 2 (SGLT-2) inhibitors for patients with comorbidities such as cardiovascular disease or chronic kidney disease." He added that sulfonylurea drugs can cause side effects such as hypoglycemia and weight gain.

Kim also criticized the government's policy, which completely blocks non-reimbursed prescriptions requiring patients to pay the full cost out of concern for misuse. "Even if patients are willing to bear the cost, they cannot access the medication," he said, urging that the general principles for diabetes medications scheduled for revision this year be changed to a class-based coverage system.

The association expressed hope that the registration of "pancreatic impairment," which will be implemented starting in July, will be a meaningful turning point to protect patients whose daily lives are restricted due to endocrine dysfunction. The registration criteria require a blood glucose level of 140 mg/dL or higher, a C-peptide (an indicator of insulin secretion capacity) level of less than 0.6 ng/mL, and at least six months of insulin treatment history.

Kim emphasized, "Recognition of disability types for severe diabetes patients must be accompanied by actual benefits, such as reduced out-of-pocket medical expenses through future designation as severe intractable diseases."

Kim Jiyoon, secretary of the association's Diabetes Specialization Task Force and professor of endocrinology and metabolism at Samsung Medical Center, pointed out the flaws in the government's policy of uniformly classifying diabetes as a mild disease. She stressed, "Patient groups with severe diabetes and high mortality risk must be managed separately."

According to the association, the mortality rate for patients with type 1 diabetes is 2.9 times higher than for non-diabetics, and patients with type 2 diabetes who use insulin also have a significantly elevated mortality risk of 2.5 times.

Professor Kim suggested, "Patients who require multiple daily insulin injections (MDI) must receive intensive, specialized education to precisely adjust insulin doses according to food intake and physical condition. The current pilot home care program, which is only available for type 1 diabetes, should be expanded to include severe type 2 diabetes patients who need insulin injections."

In fact, the pilot home care program for type 1 diabetes has shown clear benefits in preventing complications and reducing medical costs, but participation remains at just 18%.

Kim Seongrae, president of the association, said, "For diabetes, it is crucial to create an environment where patients can effectively self-manage their treatment. We will strengthen cooperation with the government and relevant organizations to raise public awareness about pancreatic impairment and ensure that patients with severe diabetes receive appropriate support and treatment without prejudice."

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