Limited Health Insurance Support for Some Patients with Endogenous Diseases
Ongoing Debate Over Coverage of Artificial Tears
Starting next year, the price of artificial tears is expected to increase by up to 10 times. This is because patients will have to bear 100% of the cost, whereas artificial tears have been available at a low price due to health insurance coverage.
The Health Insurance Review and Assessment Service (HIRA) decided at this year’s 9th Drug Benefit Evaluation Committee meeting to apply insurance benefits only to certain products of sodium hyaluronate eye drops, the main ingredient in artificial tears, and to limit the prescription quantity.
Currently, sodium hyaluronate eye drops are classified into exogenous and endogenous types depending on the disease.
Exogenous cases refer to dry eye syndrome caused by surgeries such as LASIK and LASEK, drug-induced causes, trauma, or contact lens use. Endogenous diseases refer to dry eye syndrome caused by the patient’s own conditions such as Sj?gren’s syndrome, Stevens-Johnson syndrome (Pibujeomak anjeung junggun), and keratoconjunctivitis sicca.
Going forward, insurance benefits will not be applied to patients with exogenous diseases, and will only be applied to some patients with endogenous diseases.
Currently, when prescribed eye drops for dry eye syndrome at an ophthalmology clinic, a box (60 units) can be purchased for about 4,000 KRW. However, this price reflects the amount after health insurance benefits, which is only about 10% of the actual price. Accordingly, the price of artificial tears is expected to increase by up to 10 times starting next year.
The reason HIRA is restricting health insurance coverage for artificial tears is due to health insurance finances. Every year, to maintain financial soundness, HIRA reevaluates drugs covered by health insurance benefits by assessing the efficacy and usefulness of their ingredients.
The issue of health insurance coverage for sodium hyaluronate eye drops has been discussed for a long time. At the “Health Insurance Policy Forum on Eye Drop Treatment for Dry Eye Patients” held last May, Park Eun-young, head of HIRA’s Drug Evaluation Department, pointed out, “In other countries, where the product is registered as a medical device rather than a pharmaceutical, insurance benefits for eye drops are only provided for Sj?gren’s syndrome and severe diseases.”
After receiving objections from pharmaceutical companies, HIRA plans to hold another Drug Benefit Evaluation Committee meeting and make a final decision in December.
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