Support Expanded from Rare and Incurable Diseases to Severe Diabetes... 800 Billion Won Annually for 1.97 Million People

Step-by-Step Reduction of Co-payment Rates for Severe and Rare Incurable Diseases: 10% to 7% to 5%
Support for Insulin Pumps and Continuous Glucose Monitors Extended to Severe Type 2 Diabetes

The government will reduce the medical expenses burden for patients with serious and rare incurable diseases and expand health insurance support for severe diabetes patients. As a result, approximately 1.97 million people are expected to receive annual health insurance benefits worth up to 800 billion won, including a gradual decrease in patient co-payment rates.

On September 8, the Ministry of Health and Welfare announced that it had held the Health Insurance Policy Deliberation Committee and approved the “First Phase Health Insurance Coverage Expansion Plan.” The government will prioritize alleviating the medical cost burden for patients with severe and rare diseases and turn out-of-pocket essential treatment items into insurance-covered items. At the same time, oversight of non-insurance-covered services that are prone to misuse will be strengthened.

First, for approximately 1.36 million patients with rare or serious incurable diseases, the special co-payment rate will be reduced from the current 10% to 7% in December this year, and then further down to 5% in the first half of 2028. Accordingly, the patients’ average annual out-of-pocket payment is expected to decrease from 750,000 won to 530,000 won in 2027 and 390,000 won in 2028. The estimated medical cost savings per patient range from about 220,000 to 360,000 won per year.

In particular, for diseases with high health insurance co-payment, such as hemophilia and paroxysmal nocturnal hemoglobinuria, the patient’s share will decrease significantly. For example, a hemophilia patient who currently spends 13.5 million won per year on blood coagulation factor therapy will see their out-of-pocket medical expenses fall to 9.45 million won starting this December, and down to 6.75 million won from the first half of 2028.

The number of unnecessary tests required during the re-registration process for the special co-payment system will also be reduced. Currently, patients with 312 diseases—about 340,000 people—must submit additional test results beyond clinical diagnosis every five years for re-registration. Going forward, the criteria will be improved, allowing re-registration based on clinical diagnosis and, if necessary, prior treatment history. Following improvements implemented in January for nine diseases, such as Charcot-Marie-Tooth disease, additional upgrades will be rolled out: 95 diseases including Guillain-Barre Syndrome in September, 62 more in December, and up to 146 diseases by next year.

The process for including rare disease treatment drugs under health insurance will also be expedited. The government plans to launch a rapid listing pilot project tailored to the characteristics of rare disease drugs, where treatment efficacy is difficult to verify in a short period. The pre-listing cost-effectiveness assessment will be replaced with a post-listing review based on actual clinical outcomes, and drug price negotiations will be conducted under pre-determined contract terms, reducing the current health insurance listing period from 240 days to a maximum of 100 days.

Expanded Support for Severe Diabetes... Annual Burden Reduced by 4.18 Million Won

The eligibility for support for severe diabetes will be expanded from type 1 to type 2. If a patient has severe diabetes at the level of a pancreatic disorder or pancreatic islet failure, they will be eligible for coverage of insulin pumps and continuous glucose monitors regardless of diabetes type. Consequently, about 11,000 patients with severe type 2 diabetes are newly expected to benefit from this change.

For patients with pancreatic disorders, 90% of the base cost of the insulin pump will be covered, regardless of age. The co-payment rate for type 1 diabetic patients with pancreatic disorders will be reduced from 30% to 10%, while for those with type 2 diabetes and pancreatic disorders, it will decrease from full cost to 10%. For severe type 2 diabetic patients with pancreatic islet failure, the rate will be lowered from full cost to 30%.

In particular, the support base cost for insulin pumps for young adults aged 19 to 34 will be raised to 4.5 million won, matching the support for children. If using a device costing 4.5 million won, patients in this group who previously paid 3.31 million won will see their out-of-pocket costs reduced to 450,000 won for pancreatic disorders and 1.35 million won for pancreatic islet failure.

The co-payment rate for continuous glucose monitors will also be lowered to 10-20%, depending on the severity. Furthermore, the coverage for the remote management pilot program will be extended to include severe type 2 diabetes, providing remote consultations and monitoring services. The government expects this will reduce the annual burden by 360,000 won for type 1 diabetic patients and by 4.18 million won for severe type 2 diabetes patients.

Support for remote management will also be expanded for patients with rare diseases such as glycogen storage disease and neurogenic bladder. For approximately 344 glycogen storage disease patients, blood glucose test strips, lancets, and electrodes for continuous glucose monitoring will be provided. For around 11,000 neurogenic bladder patients, support criteria for self-catheterization catheters will be expanded. Consequently, the annual medical cost burden is expected to drop by about 3.5 million won and 1.55 million won, respectively.

Additionally, for specialized care hospitals treating rare muscle diseases such as amyotrophic lateral sclerosis (ALS), separate compensation plans will be considered, taking into account specialized treatment, public functions, and caregiving for patients with severe rare diseases.

From January next year, dental implants for up to two teeth will be supported for people aged 65 and older who have lost all their teeth. An estimated 70,000 people will benefit, receiving support worth approximately 2.28 million won per person. The age coverage for light-curing resin in children and adolescents will also be expanded from ages 5-12 to ages 5-13, providing an expected annual medical cost benefit of 220,000 won to about 140,000 children.

Starting with this first-stage plan, the Ministry of Health and Welfare plans to gradually expand health insurance coverage by further reducing the burden of caregiving and strengthening dental coverage. The total support size for this first phase is set at 1.97 million people, amounting to 600 to 800 billion won annually.

Jang Youngjin, Director of Health Insurance Policy at the Ministry of Health and Welfare, stated, "With expanded insurance coverage for people with severe and rare diseases, the elderly, and children and adolescents, the burden of medical expenses is now eased, enabling more proactive treatment and management. We will continue to push for expanded health insurance coverage based on a comprehensive road map for strengthening the health insurance program."

This content was produced with the assistance of AI translation services.