Ministry of Health and Welfare Holds the 14th Health Insurance Policy Deliberation Committee Meeting
[Asia Economy Reporter Kim Young-won] Health insurance coverage will newly apply to the esophagitis treatment drug 'Pexuclu' and the 'Continuous Glucose Monitoring (CGM) test' conducted using continuous glucose monitors for diabetes patients.
On the 28th, the Ministry of Health and Welfare held a meeting of the Health Insurance Policy Deliberation Committee (HPC), the highest decision-making body for health insurance, and announced the revision of the drug benefit list and benefit ceiling price table
, and the approval of health insurance coverage for continuous glucose monitoring tests.
The HPC decided to apply health insurance coverage to Pexuclu, a treatment for erosive esophagitis, starting from the 1st of next month. Accordingly, the cost of Pexuclu, which was about 60,000 KRW per year without insurance coverage, will be reduced to about 15,000 KRW (with a 30% co-payment).
Pexuclu from Daewoong Pharmaceutical is a 'Potassium-Competitive Acid Blocker (P-CAB)' drug that must be taken 30 minutes before meals and improves on the drawbacks of existing esophagitis treatments, 'Proton Pump Inhibitors (PPI),' which promote nighttime acid secretion.
Initially, Daewoong Pharmaceutical aimed for a higher price than HK Innoen's 'K-CAB (active ingredient: Tegoprazan),' which is also a P-CAB drug, but the Health Insurance Review and Assessment Service's Drug Benefit Evaluation Committee granted conditional approval on the basis of 'acceptance below the evaluated price.' It was determined that a weighted average price between K-CAB (1,300 KRW per tablet) and existing PPI treatments (700?1,100 KRW) was appropriate. The final ceiling price for Pexuclu was set at 939 KRW per tablet, similar to PPI treatments.
The health insurance coverage scope for Roche's anticancer drug 'Kadcyla,' which is currently covered by health insurance, will be expanded. Previously, the coverage was limited to 'second-line treatment for locally advanced or metastatic breast cancer,' but going forward, coverage will extend to 'adjuvant therapy after early breast cancer surgery.'
With health insurance coverage, when Kadcyla is administered as adjuvant therapy after early breast cancer surgery, the cost per administration will be reduced from 70 million KRW without insurance to a maximum of 3.5 million KRW (with a 5% co-payment), resulting in a reduction of about 66.5 million KRW.
Health Insurance Fees Applied for Education and Interpretation of Continuous Glucose Monitor Use
Health insurance fees will also be applied when educating type 1 diabetes patients on how to use their continuous glucose monitors by attaching the device or when interpreting the results after a certain period of use during hospital visits.
A continuous glucose monitor is a device that attaches a sensor to the skin to measure blood glucose levels in real time and notify changes. Unlike general self-monitoring blood glucose meters (BGM), which require the cumbersome process of pricking a finger to collect blood, CGM automatically measures glucose levels for about 15 days with a single attachment.
Currently, consumable materials such as continuous glucose monitors and electrodes used for blood glucose management in diabetes patients are supported through health insurance nursing fees paid in cash after the fact. However, medical procedures such as conducting tests using continuous glucose monitors or interpreting test results at medical institutions are operated as non-covered services costing about 87,200 KRW per session. Consequently, there have been ongoing calls for professional management to ensure proper use of the devices.
Following this decision, when receiving continuous glucose monitoring tests at tertiary general hospitals, the patient's co-payment will decrease to approximately 10,710 KRW to 18,540 KRW (60% applied for outpatient visits at tertiary general hospitals).
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