COVID-19 drugs to be reimbursable, "KRW 50,000 co-payment"

Paxlovid and Veklury will be reimbursable…reimbursement coverage for Zejula will be expanded

Extended NHI support for emergency care, costing KRW 208.5 billion per month

The National Health Insurance will cover two COVID-19 treatments, Paxlovid and Veklury, starting on October 1st.

 

The government will list COVID-19 treatments for reimbursement and make a policy revision to support the patient co-payment at the previous price of KRW 50,000.

 

The National Health Insurance coverage for Takeda Pharmaceuticals Korea's Zejula Cap (ingredient: niraparib tosylate monohydrate), a treatment for advanced ovarian cancer, will be expended, and the ceiling price of the drug will be reduced, starting on October 1st.

 

Patients with advanced ovarian cancer who paid KRW 41 million in annual treatment costs per person are expected to pay KRW 2..05 million in annual treatment costs with the National Health Insurance coverage.

 

On September 26th, the Ministry of Health and Welfare (MOHW) held the 19th Health Insurance Policy Review Committee meeting and decided on items related to National Health Insurance coverage of COVID-19 treatments and expanded National Health Insurance coverage for Zejula Cap.

 

COVID-19 drugs will be covered by NHI…expanded reimbursement for Zejula The two COVID-19 treatments that the Korea Disease Control and Prevention Agency (KDCA) purchased and supplied will be covered by the National Health Insurance, starting in October.

 

Those two are Paxlovid and Veklury.

 

The ceiling price for Pfizer Korea's 'Paxlovid' is KRW 941,940 per 30 tablets in a package, and that for Gilead Sciences Korea's 'Veklury 100mg Powder For Concentrate For Solution For Infusion' is KRW 520,000 per vial.

 

The related policy will be revised along with the reimbursement listing of these drugs.

 

As an administrative action to prevent patient co-payment increases due to reimbursement, the co-payment will be maintained at the current cost of KRW 50,000.

 

Starting next month, the reimbursement coverage for Zejula Cap, a treatment for advanced ovarian cancer, fallopian tube cancer, and primary peritoneal cancer, will be expanded, and its ceiling price will be reduced.

 

For Zejula Cap, the usage criteria will be expanded, and it will be reimbursable for maintenance therapy of patients with advanced epithelial ovarian cancer, fallopian tube cancer, and peritoneal cancer who are responsive to the first-line platinum-based therapy.

 

Previously, it was reimbursable only when the patients tested BRCA mutation-positive ovarian cancer from genetic screening.

 

Starting next month, the drug will also be reimbursable in all homologous recombination deficiency-positive genetic mutations, including ovarian cancer-associated genomic instability identified from genetic testing.

 

Patients with advanced ovarian cancer who paid KRW 41 million in annual treatment costs per person are expected to pay KRW 2..05 million in annual treatment costs with the National Health Insurance coverage.

 

The pilot project for primary healthcare home visits will be improved Since December 2019, the government has been implementing a pilot project for primary healthcare home visits, a healthcare service in which private clinic doctors visit patient homes, to enhance healthcare access for patients who have difficulties visiting medical centers.

 

Starting in November, the designation of medical centers for healthcare home visits will be expanded to include hospitals (local medical centers).

 

Peviously, only private clinics and oriental medicine clinics were eligible for designation.

 

Now, hospitals (local medical centers) can also participate following the policy revision.

 

It will be expanded for patients with severe disease who require home medical care, including bedridden patients with Grade 1·2 long-term care and patients with severe disease using medical devices (oxygen therapy and a respirator).

 

Co-patients for home visits will be reduced for these patients.

 

In order to implement a reduction in out-of-pocket costs for eligible patients, a medical center's screening process will be developed.

 

Additionally, a computer system for patients to claim the reduction of out-of-pocket costs is also in development.

 

The implementation of the out-of-pocket cost reduction is scheduled to occur after November.

 

In addition, to expand the primary healthcare home visit project, additional participating institutions will be invited in October.

 

Extended NHI support for emergency care The policy for providing the National Health Insurance coverage for emergency care, which costs KRW 208.5 billion per month, will be extended to prevent a gap in healthcare for patients with severe and emergent symptoms amid the doctor's strike.

 

The budget will be used to strengthen compensation for emergency departments and tertiary general hospitals so that they can focus on the treatment of emergency and patients with severe symptoms, and for the return of patients with mild symptoms to hospitals and clinics.

 

Incentives will be increased to ensure the prompt transport of critical patients to hospitals.

 

Additionally, incentives for medical care in emergency centers, including emergency care fees and CPR fees, will be enhanced.

 

To facilitate prompt hospital responses to critical patient emergencies, the government will provide financial support for specialists treating hospitalized critical patients and incentives for critical patient hospitalization.

 

The emergency medical care analysis comparing year-over-year from March to July 2024 shows that hospitals are maintaining critical patient care systems.

 

However, the number of critical patients visiting the regional·local emergency medical centers has slightly decreased.

 

The government will extend additional support to strengthen emergency care treatment capacity.

 

The government will also extend raises for specialist medical fees, which were temporarily implemented during Chuseok to maintain the infrastructure of critical·emergency patient treatment at emergency medical centers.

 

The raises for critical·emergency surgeries will also be extended.

 

The raises in specialist medical fees will be 250% for regional·special emergency medical centers and 150% for local emergency medical centers.

 

The raises for critical·emergency surgeries at regional·special·local emergency medical centers will be 200%.

 

The MOHW stated, "We will provide a temporary insurance fee for emergency medical care to prevent a medical care gap for emergency and critical patients.

 

We aim to promptly solve the current situation to ensure people do not encounter difficulties using medical centers."