’Social consensus is key’ to hair loss drug reimb in Korea

Attention rises on the Ministry of the Interior and Safety’s discussion next month...will discuss ‘health insurance efficacy and perceived benefits’ by age group and social class.

“Practical review of eligibility, criteria, and reimbursement methods already completed… Implant coverage serves as a precedent”

MOHW Director Jung-Min Yoo

Discussions on expanding National Health Insurance (NHI) reimbursement coverage for hair loss treatments are expected to gain momentum, following Health and Welfare Minister Eun-kyeong Jeong’s announcement of the public collection of opinion on reimbursment for hair loss medications, one of President Jae-myung Lee’s campaign pledges, as a major policy priority in the second half of this year.

The Ministry of Health and Welfare (MOHW) appears to have already established much of the practical framework for various scenarios, including eligibility criteria, reimbursement methods, and financing, so that the policy can be implemented immediately without administrative delays once a social consensus is reached.

Jung-min Yoo, Director of the MOHW’s Insurance Benefits Division, recently outlined the ministry’s preparations and future plans regarding insurance coverage for hair loss medications during a meeting with healthcare reporters.

Following Minister Jung’s announcement that the government will gather public opinion on the issue, the citizen-participation forum ‘Everyone’s Forum,’ hosted by the Ministry of the Interior and Safety on July 4, is expected to be a critical turning point in determining whether insurance coverage for hair-loss treatments will be available.

“Hair loss is not merely a cosmetic issue, but a disease”… Focus on intergenerational equity in insurance contributions

The discussion is rooted in President Lee’s comments regarding “intergenerational equity in health insurance contributions” and the recognition of hair loss as a medical condition.

Yoo said, “The perceived benefits of health insurance reimbursement differ among social classes. Hair loss is not purely a cosmetic concern. It has a diagnostic disease code, and dermatology societies already have assessment tools to evaluate disease severity.”

Due to its clear disease characteristics, the ministry intends to determine whether the public insurance budget should be allocated to hair loss based on the outcome of broader social discussions.

Yoo emphasized, “We have set up simulations so that regardless of the direction of public consensus, the ministry’s internal reviews do not become a source of delay. We have already reviewed multiple options and financial scenarios so that the policy can be launched immediately once the reimbursement scope and coverage method are determined.”

Biggest issue lies in ‘eligibility and criteria’…”Practical review already completed”

Some healthcare experts have argued that the greatest challenge in reimbursing hair loss treatments would be in ‘defining eligible patients and reimbursement criteria.’ Even if public demand exists, determining patient coinsurance levels and treatment scope remains a complex task.

In response, Yoo cited the example of ‘dental implant reimbursement,’ which was initially limited to individuals aged 65 and older. Yoo explained that a direction has been set for its reimbursement after extensive discussions with academic societies under President Lee’s direction last December.

Yoo said, “Androgenetic alopecia has an established disease code, and academic societies possess age-specific prevalence data. Drug prices have declined significantly compared with when the campaign pledge was first announced, and some hair loss medications are already reimbursed for prostate disease treatment. We have considered these factors comprehensively and completed the practical groundwork.”

Public forum to engage without a fixed budget cap… key issue will be manufacturers’ reimbursement applications

The ministry does not plan to predetermine the budget by setting an upper limit such as “within KRW 1 trillion.” Instead, it intends to consider all possibilities.

Based on pre- and post-forum surveys and in-depth discussions conducted during the July forum, the government plans to assess public consensus and then determine the final scope of coverage and funding.

However, gaining active participation from pharmaceutical companies will also be an important task. While the government can directly decide reimbursement for medical procedures, drug reimbursement requires manufacturers to submit applications for listing and propose an appropriate reimbursement ceiling price before reimbursement evaluations can even begin.

Yoo said, “Procedural requirements cannot be skipped. However, if public opinion favors swift implementation, there will be no delays on MOHW’s part during subsequent stages, including division-level discussions and deliberations by the Health Insurance Policy Deliberation Committee once manufacturers submit their applications.”