Health Insurance Coverage to Begin for Five Rare and Intractable Disease Treatments Next Month

"ტერესCrysvita" coverage extended to adults with rickets
New treatments for depression, epilepsy, and bile duct cancer also reduce patients' out-of-pocket costs

Starting next month, national health insurance coverage will be newly introduced or expanded for five treatments for rare and intractable diseases. Coverage for a treatment for hypophosphatemic rickets and osteomalacia, previously limited to children, will be extended to adults. Patients with depression and intractable epilepsy who have not responded to existing treatments will also gain new treatment options.

The Ministry of Health and Welfare announced on October 29 that, following deliberations by the Health Insurance Policy Deliberation Committee, national health insurance coverage for five treatments for rare and intractable diseases would be introduced or expanded starting November 1. The change is expected to reduce medical expenses for patients who have so far had to pay the full cost of their medication out of pocket. Under national health insurance, the patient copayment rate is 10% for people with rare diseases and 5% for cancer patients, among others.

First, coverage for Crysvita Injection, a treatment for hypophosphatemic rickets and osteomalacia, will be extended from children to adults. This rare disease occurs when a lack of phosphate, which is needed for bone formation, prevents bones from developing properly or weakens them. The prevalence among adults is about 6.7 per million people. Until now, some patients treated during childhood had to stop treatment upon reaching adulthood, while others whose symptoms appeared in adulthood could not receive appropriate care. The expanded coverage is expected to allow adults to continue treatment and reduce gaps in care.

Oxlumo, a treatment for primary hyperoxaluria type 1, will newly be covered by national health insurance. The disease results from a genetic defect that disrupts oxalate metabolism in the liver, causing excessive oxalate production. Its prevalence is only 1 to 3 per million people. It can cause calcium oxalate stones, blood in the urine, and kidney calcification, and repeated kidney damage can lead to chronic kidney disease or end-stage renal failure. Until now, there were virtually no fundamental treatment options other than liver or kidney transplantation. With the new coverage, the progression of kidney damage is expected to be slowed at an early stage.

Spravato Nasal Spray will be covered for patients with treatment-resistant depression who do not respond to existing antidepressants. It is intended for patients with moderate to severe major depressive disorder who have not responded despite taking at least two types of antidepressants. The Ministry of Health and Welfare said that major depressive disorder affects about 5% of adults in South Korea and that up to 30% of those patients are estimated to have treatment-resistant depression that does not respond to existing antidepressants. The aim is to reduce gaps in care by expanding treatment options and to support early intervention for people at high risk of suicide.

Xcopri tablets, a domestically developed new drug, will be covered for patients with intractable epilepsy whose seizures are not controlled with existing medications. About 30% of people with epilepsy are known to have difficulty controlling their symptoms with existing medications. The drug was launched overseas before becoming available in South Korea, forcing Korean patients to import it from abroad for years. The new coverage will reduce the financial and logistical burden on patients.

Tibsovo tablets, a treatment for locally advanced or metastatic cholangiocarcinoma, will also be covered by national health insurance. The coverage applies to patients whose cancer cells have an IDH1 gene mutation associated with tumor growth. Cholangiocarcinoma is difficult to diagnose early and tends to spread to surrounding tissue. Its five-year relative survival rate from 2019 to 2023 was just 29.0%, far below the average of 73.7% for all cancers. Patients with an IDH1 mutation, found in 10% to 20% of all cholangiocarcinoma cases, had few nationally insured targeted cancer drug options beyond existing chemotherapy. The new coverage is expected to improve access to treatment.

Lee Hyunghoon, the Ministry of Health and Welfare's Second Vice Minister, said, "I hope this expanded national health insurance coverage will ensure meaningful treatment opportunities for people with rare diseases, who have received limited public attention because there are so few patients, as well as for people with intractable diseases who have not benefited from existing medications. We will continue to strengthen insurance coverage for treatments for rare and intractable diseases so that no one is left without access to treatment."

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