South Korea Expands Health Insurance to Cut Costs for Rare Diseases and Severe Diabetes
核心洞察
South Korea's Ministry of Health and Welfare approved a first-phase health insurance coverage expansion plan expected to benefit approximately 1.97 million people with up to 800 billion won annually.
The special co-payment rate for roughly 1.36 million patients with rare or serious incurable diseases will fall from 10% to 7% this December, then to 5% in the first half of 2028.
Coverage for severe diabetes will expand from type 1 to type 2, extending insulin pump and continuous glucose monitor benefits to about 11,000 additional patients.
South Korea's Ministry of Health and Welfare has approved a sweeping "First Phase Health Insurance Coverage Expansion Plan" that will reduce out-of-pocket medical costs for patients with severe and rare diseases while extending benefits to severe diabetes patients. Announced on September 8 following a Health Insurance Policy Deliberation Committee meeting, the plan is expected to deliver annual health insurance benefits worth up to 800 billion won to approximately 1.97 million people.
The initiative prioritizes alleviating the medical cost burden for patients with severe and rare diseases, converting out-of-pocket essential treatment items into insurance-covered items while strengthening oversight of non-insurance-covered services prone to misuse.
Reduced Co-Payments for Rare and Incurable Diseases
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 further down to 5% in the first half of 2028. As a result, 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, with estimated savings per patient ranging from about 220,000 to 360,000 won per year.
The impact is especially pronounced for diseases with high health insurance co-payments, such as hemophilia (搜索) and paroxysmal nocturnal hemoglobinuria (搜索). A hemophilia patient currently spending 13.5 million won per year on blood coagulation factor therapy will see out-of-pocket expenses fall to 9.45 million won starting this December, and down to 6.75 million won from the first half of 2028.
The re-registration process for the special co-payment system will also be streamlined. Currently, patients with 312 diseases—about 340,000 people—must submit additional test results beyond clinical diagnosis every five years. Going forward, re-registration will be permitted 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 cover 95 diseases including Guillain-Barre Syndrome in September, 62 more in December, and up to 146 diseases by next year.
Faster Listing for Rare Disease Drugs
The government will expedite the process for including rare disease treatment drugs under health insurance through 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. This approach reduces the current health insurance listing period from 240 days to a maximum of 100 days.
Expanded Coverage for Severe Diabetes
Eligibility for severe diabetes support will expand from type 1 to type 2. Patients with severe diabetes at the level of a pancreatic disorder or pancreatic islet failure will be eligible for coverage of insulin pumps and continuous glucose monitors regardless of diabetes type, bringing about 11,000 patients with severe type 2 diabetes (搜索) into the program.
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 (搜索) 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%.
The support base cost for insulin pumps for young adults aged 19 to 34 will be raised to 4.5 million won, matching support for children. A patient in this group using a 4.5 million won device who previously paid 3.31 million won will see 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 severity, and remote management pilot program coverage will extend to severe type 2 diabetes (搜索). The government expects this to 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 Rare Diseases and Specialized Care
Remote management support will expand for patients with rare diseases such as glycogen storage disease (搜索) and neurogenic bladder. Approximately 344 glycogen storage disease patients will receive blood glucose test strips, lancets, and electrodes for continuous glucose monitoring, while around 11,000 neurogenic bladder patients will see expanded support criteria for self-catheterization catheters. Annual medical cost burdens are expected to drop by about 3.5 million won and 1.55 million won, respectively.
For specialized care hospitals treating rare muscle diseases such as amyotrophic lateral sclerosis (搜索) (ALS), separate compensation plans will be considered, accounting for specialized treatment, public functions, and caregiving for patients with severe rare diseases.
New Drug Coverage for Rare Epilepsy and Blood Cancers
In a related announcement on September 1, the ministry said it will apply national health insurance coverage to Fintepla, a treatment for Dravet syndrome (搜索), a rare and intractable epilepsy that begins in infancy and causes severe seizures and developmental delays. The ministry projected that coverage for Fintepla will lower medical costs to about 10 million won per patient per year from roughly 100 million won.
Fintepla was selected for a pilot program that runs approval by the Ministry of Food and Drug Safety in parallel with reimbursement assessment and price negotiations by the Health Insurance Review and Assessment Service, cutting the time needed to secure insurance coverage to 126 days from 240 days.
Polivy, a new drug used in the initial treatment stage for diffuse large B-cell lymphoma (搜索), will also be newly covered. Blincyto, a treatment for B-cell precursor acute lymphoblastic leukemia (搜索), will see its coverage expanded. Previously covered only when cancer recurred or existing treatments failed, Blincyto will now be available from the early treatment stage, when it is used to clear residual microscopic cancer cells immediately after a first round of chemotherapy. Because the disease occurs most often in children under 5, the ministry expects the change to lower relapse risk in pediatric patients and widen their chances of full recovery.
Essential Medicine Supply and Broader Coverage
The ministry will also strengthen support for the stable supply of essential medicines. Choongwae Protamine 6% Injection, used to regulate blood pressure and stabilize blood circulation in newborns and premature infants, will be newly designated as a drug protected from market withdrawal, establishing a framework to cover its production costs. For Tuberculin PPD AJV Injection, a tuberculosis diagnostic reagent whose supply had been at risk due to rising import prices, the higher import price will be reflected promptly.
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, benefiting an estimated 70,000 people with support worth approximately 2.28 million won per person. Age coverage for light-curing resin in children and adolescents will expand from ages 5–12 to 5–13, providing an expected annual medical cost benefit of 220,000 won to about 140,000 children.
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."
Yoo Joo-heon, director general of the ministry's health insurance policy bureau, added, "We will continue to pursue rapid health insurance coverage for treatments for severe and rare diseases, and ensure that medicines essential to patient care are supplied stably."