Korea’s health authorities are reviewing diabetes drug reimbursement rules that may be limiting access to newer treatments, including Novo Nordisk’s Ozempic (semaglutide), the Korean Diabetes Association (KDA) said Friday.
According to KDA, the Ministry of Health and Welfare and the National Health Insurance Service (NHIS) are assessing proposed changes to rules first set in 2011, with revisions possible this year.
The changes could give doctors more flexibility to choose diabetes drugs based on patients’ heart, kidney and other risks rather than a fixed sequence of older medicines.
Kim Chong-hwa, insurance policy director at the Korean Diabetes Association, at Friday’s diabetes policy press conference in Seoul. (Credit: Korea Biomedical Review)
Under current rules, Ozempic is reimbursed only after patients fail two to four months of metformin plus a sulfonylurea, an older drug class now used less often because of hypoglycemia and weight-gain risks.
Patients must also have HbA1c, a measure of average blood sugar, of at least 7 percent and either a body mass index (BMI) of at least 25 kg/m² or be unable to use insulin.
“The current criteria require prior use of specific drugs, which does not fit clinical practice,” said Kim Chong-hwa, director of the association’s committee of health insurance, noting that the most common two-drug regimens in Korea now combine metformin with a DPP-4 inhibitor or SGLT-2 inhibitor rather than a sulfonylurea.
The association wants reimbursement expanded to those more common combinations, BMI restrictions eased and access broadened for patients with cardiovascular disease, chronic kidney disease or heart failure.
Kim said the rules should not be based only on blood sugar and BMI, but also on clinical benefits such as preventing cardiovascular and kidney complications.
Health authorities created separate Ozempic rules partly to prevent misuse for weight loss, because semaglutide is also sold as the obesity drug Wegovy. Doctors say the restrictions can also affect diabetes patients who need to switch from other GLP-1 drugs or adjust doses for treatment reasons.
The broader review covers Korea’s general diabetes drug reimbursement principles, which still start with metformin and add drugs in a stepwise order. Kim said the framework was created “too long ago” and has not kept pace with newer drugs or guidelines that no longer treat metformin as the only first-line option.
The association said it is discussing revisions with the Ministry of Health and Welfare and the Health Insurance Review and Assessment Service, with a financial impact review underway. Kim said the group expects the general principles to be revised by the end of the year at the latest.
Separately, the association called for more support for severe diabetes as pancreatic disorder is set to become Korea’s 16th disability category in July.
The designation may cover many type 1 diabetes patients and some type 2 patients with severe pancreatic insulin deficiency, but it will not by itself qualify them for Korea’s special copayment reduction program, meaning patients may still face the same out-of-pocket treatment costs.
Doctors also want continuous glucose monitors and insulin pumps moved from a reimbursement-after-purchase system to direct insurance coverage. Kim called the current process, which requires patients to pay first and claim money back later, “very cumbersome.”
Kim Ji-hye
댓글
0