[DiaryPoint = Reporter Park Bo-young] South Korea’s National Health Insurance coverage for five rare and hard-to-treat disease treatments took effect on November 1. Xcopri tablets, Spravato nasal spray, Oxlumo injections, and Tibsovo tablets were newly added to the coverage list, while Crysvita injection coverage was expanded from children to adults.
The change does not mean that anyone can receive insurance coverage simply because they are prescribed one of these drugs. Patients must meet drug-specific criteria, which may include a diagnosis, disease status, and response to previous treatment. Patients and their families should check eligibility with the treating clinician before a prescription is issued.
Four newly covered drugs: check the disease and eligibility criteria
Xcopri tablets are newly covered for patients whose seizures are not adequately controlled with existing epilepsy medications. Spravato nasal spray is for patients with moderate-to-severe major depressive disorder who have not responded to at least two different antidepressants.
Oxlumo injections are newly covered for the treatment of primary hyperoxaluria type 1. Tibsovo tablets are a targeted therapy for locally advanced or metastatic cholangiocarcinoma with an IDH1 mutation. Because a disease name alone may not determine eligibility, patients should review their test results and the detailed criteria with their care team.
Crysvita coverage expands from children to adults
Insurance coverage for Crysvita injection, a treatment for hypophosphatemic rickets and osteomalacia, has been extended to adults. This may open access for patients who continue treatment after reaching adulthood, as well as those diagnosed as adults.
The Ministry of Health and Welfare said patients with rare diseases generally pay 10% of the treatment cost out of pocket, while cancer patients pay 5%. These rates alone do not determine the final bill. The amount can vary based on a patient’s eligibility, how the drug is prescribed or administered, and whether the treatment meets coverage criteria. Services not covered by insurance may be billed separately.
Patients can ask the hospital prescribing or administering the drug to confirm coverage and estimated out-of-pocket costs by providing the drug name, diagnosis, and test results. After treatment, the bill and receipt show covered and non-covered items and the patient’s share. If the hospital cannot confirm coverage, patients can contact the National Health Insurance Service at 1577-1000.
The expanded coverage has been in effect since November 1. The ministry’s announcement did not specify an application deadline. Patients should first confirm the coverage criteria and costs with their hospital before treatment is prescribed.