Retevmo, Vyloy and Padcev+Keytruda reimbursed from Oct. 1

MOHW, “to ease treatment cost burden for patients with rare, underserved cancers”

National Health Insurance reimbursement will take effect on Oct. 1 for Retevmo Cap, a treatment for non-small cell lung cancer with a rare genetic alteration and medullary thyroid cancer; Vyloy, a treatment for advanced or metastatic gastric cancer; and the Padcev-Keytruda combination as first-line treatment for urothelial cancer.

The expanded reimbursement coverage is expected to help extend the lives of patients with rare and underserved cancers who have faced high out-of-pocket drug costs, while easing the financial burden on their families.

On the 30th, the Ministry of Health and Welfare said that the Health Insurance Policy Deliberation Committee had approved expanding NHI coverage for the cancer treatments.

Retevmo Cap is a targeted therapy for non-small cell lung cancer and medullary thyroid cancer with a rare genetic alteration (RET fusion). The number of eligible patients in Korea is estimated at fewer than 300. Compared with conventional cytotoxic chemotherapy, the drug reduces adverse effects while improving treatment efficacy. As an oral therapy, it also substantially reduces the burden of hospital visits and waiting times for patients.

Vyloy is a new treatment for patients with unresectable advanced or metastatic gastric cancer, a difficult-to-treat disease with a 5-year relative survival rate of around 10%.

Compared with existing treatment, Vyloy was shown to reduce the risk of developing resistance by 41% and nearly double overall survival.

NHI coverage will also apply to the Padcev-Keytruda combination as first-line treatment for urothelial cancer. The combination will be covered from the first line of treatment for patients with urothelial cancer, which accounts for approximately 2.5% of all cancers. Combining Padcev, which targets cancer cells, with Keytruda, which activates immune cells, nearly doubled survival compared with conventional treatment.

Notably, reimbursement of the Padcev(Astellas Korea) and Keytruda (MSD) combination, respectively, marks the first time Korea’s NHI has covered a combination regimen involving high-cost new drugs developed by different pharmaceutical companies. The case also carries policy significance as coverage was achieved by coordinating separate negotiations and interests between the two drugmakers to close a gap in treatment access. The government plans to use the case as a basis for further improvements to the NHI reimbursement framework for combination regimens involving new drugs.

Hyung Hoon Lee, Second Vice Minister of Health and Welfare, said, “This will substantially ease the financial burden on patients and families who have had to delay or forgo treatment because of high drug costs. We will continue endeavors to expand National Health Insurance coverage to treatments for rare and severe diseases.”