Obesity Drug 'Mounjaro' Passes First Hurdle for Health Insurance Coverage

Drug Evaluation Committee Recognizes Reimbursement Appropriateness
for Adult Type 2 Diabetes Patients

'Mounjaro (active ingredient Tirzepatide)', which is used as an obesity treatment, has moved a step closer to being covered by health insurance for diabetes patients.

'Mounjaro (active ingredient: Tirzepatide)'. Eli Lilly

On December 4, the Health Insurance Review and Assessment Service convened the Drug Reimbursement Evaluation Committee and recognized that Mounjaro is appropriate for reimbursement when used as an adjunct to diet and exercise therapy for improving blood sugar control in adult patients with type 2 diabetes. The final decision on reimbursement will be made after price negotiations with the National Health Insurance Service and a review by the Health Insurance Policy Deliberation Committee of the Ministry of Health and Welfare.

Diabetes is classified as either type 1 or type 2 depending on the cause. Type 2 diabetes commonly occurs due to various factors such as metabolic syndrome or obesity, resulting in insufficient insulin secretion or impaired insulin function. The committee's recognition of reimbursement appropriateness applies specifically to type 2 diabetes and does not include obesity treatment.

Accordingly, when adult type 2 diabetes patients are prescribed Mounjaro, which is also an obesity treatment, about 70% of the drug cost will be covered by health insurance.

Additionally, on the same day, the committee determined that reimbursement is appropriate for Samo Pharmaceutical's 'Voxzogo Injection (active ingredient Vosoritide)' for pediatric patients with achondroplasia whose growth plates have not closed, and for AbbVie Korea's 'Epkinly Injection (active ingredient Epcoritamab)' for adult patients with relapsed or refractory lymphoma.

For Janssen Korea's pulmonary arterial hypertension treatment 'Opsynvi Tablet (active ingredients Macitentan and Tadalafil)' and Mitsubishi Tanabe Pharma's anemia treatment 'Vadanem Tablet (active ingredient Vadadustat)', the committee indicated that reimbursement may be possible if the drug prices are set below the evaluation amount presented by the committee.