[Desk View] Can NHI alone cover the costs of cancer drugs?

The reimbursement claim amount submitted for anti-cancer drugs has been increasing robustly every year.

 

According to the '2024 Pharmaceutical Reimbursement Claims Data' published by the Health Insurance Review & Assessment Service, drug expenditure for cancer diseases in 2024 amounted to KRW 4.1372 trillion, a 7.4% increase from KRW 3.8506 trillion in 2023.

 

The rate of increase in cancer drug expenditures is steeper than the 4.5% increase for overall drug expenditures (KRW 26.9897 trillion).

 

These data indicate that the costs of anti-cancer drugs are rising with the emergence of expensive drugs like immunotherapies and targeted therapies.

 

The problem lies in what comes next.

 

If the anti-cancer drugs currently awaiting reimbursement approval are approved, an additional KRW 2-3 trillion is expected to be added soon.

 

The national health insurance, which is accumulating financial deficits, may no longer be able to cover these rising costs of anti-cancer drugs.

 

Global pharmaceutical companies are increasingly combining new anti-cancer drugs or expanding investments in more expensive first-line treatments.

 

As a result, cancer treatment is evolving.

 

However, the latest high-cost anti-cancer drugs are waiting in a long queue for reimbursement, putting a burden on national health insurance finances.

 

Some are suggesting that the 5% patient co-payment rate for anti-cancer drugs should be slightly increased.

 

However, adjusting a patient's co-payment rate once it has been lowered is not an easy task.

 

The government and politicians probably refrain from such a move, as it could cost them votes.

 

For this reason, there is a growing argument that South Korea should also establish a separate fund for anti-cancer or rare disease drugs, similar to the UK, to save national health insurance finances and improve access to new drugs.

 

However, the government does not seem to be acknowledging the seriousness of this issue yet.

 

During the candidacy confirmation hearing, Jeong Eun Kyeong, Minister of Health and Welfare, expressed the view that expanding reimbursement coverage should be prioritized over creating a separate fund for patients with rare and severe diseases.

 

The issue of national health insurance drug expenditures is not new, but the current instability differs from past patterns.

 

In particular, merely adjusting the prices of drugs with expired patents, as in the past, has limited effectiveness in alleviating the financial pressure caused by the entry of high-cost drugs, such as innovative new anti-cancer drugs.

 

It is also difficult for the government not to permit the entry of new, more effective anti-cancer drugs.

 

The financial losses caused by these innovative anti-cancer drugs are, therefore, unavoidable.

 

In this situation, it isn't easy to solve both financial stability and access to new drugs with past methods of drug cost reduction or reimbursement expansion.

 

We hope that the new government realizes the seriousness of the cancer drug expenditure problem and prioritizes its policies.