National Health Insurance Coverage for Rare and Underserved Cancer Treatments to Expand in October

[Financial News] Starting in October, health insurance coverage will be extended to a treatment for lung cancer with rare genetic mutations, a treatment for advanced and metastatic gastric cancer, and a combination therapy for urothelial carcinoma. As patients' financial burden for expensive new cancer drugs declines, access to treatment for those with rare and underserved cancers is expected to improve.
The Ministry of Health and Welfare (MOHW) announced on the 30th that, beginning October 1, health insurance coverage will apply to Retevmo Capsules, a treatment for lung cancer with rare genetic mutations; Vyloy, a treatment for unresectable advanced and metastatic gastric cancer; and the Padcev–Keytruda combination therapy, a first-line treatment for urothelial carcinoma. The measures were decided after review by the National Health Insurance Policy Deliberation Committee.
First, Retevmo Capsules is a targeted cancer drug used to treat non-small cell lung cancer and medullary thyroid cancer caused by a rare genetic mutation known as RET fusion. Non-small cell lung cancer involving RET fusion accounts for approximately 1–2% of all lung cancer cases, and the number of patients in Korea is estimated at fewer than 300.
Retevmo Capsules targets and attacks specific mutations in cancer cells. Compared with conventional cytotoxic chemotherapy, it is designed to improve treatment efficacy and reduce side effects. Because it is an oral medication rather than an injectable drug, it is also expected to ease the burden on patients who must visit a hospital for injections each time.
Vyloy, a treatment for advanced or metastatic gastric cancer, has also been included in the health insurance coverage. The five-year relative survival rate for gastric cancer overall is 78.6%, but unresectable advanced or metastatic gastric cancer is considered difficult to treat, with a median survival of six to 10 months and a five-year relative survival rate of only around 10%.
Coverage for Vyloy was approved based on clinical results showing that it reduced the risk of resistance by 41% compared with existing treatments and nearly doubled overall survival. The measure is expected to improve access to treatment for patients with advanced or metastatic gastric cancer, who face a heavy financial burden.
For urothelial carcinoma, health insurance coverage will apply to the first-line combination therapy of Padcev and Keytruda. Urothelial carcinoma is an underserved cancer that accounts for approximately 2.5% of all cancer cases. Because the disease progresses rapidly, early treatment is important.
Previously, Keytruda could be used under health insurance coverage only as a second-line treatment after failure of first-line therapy. Under the new measure, it can be used with Padcev from the first-line treatment stage. Padcev targets and attacks cancer cells, while Keytruda helps the immune system fight cancer, allowing the two drugs to work through different mechanisms.
In clinical trials, the combination therapy extended overall survival by approximately twofold compared with existing treatments. The measure is also significant because it is effectively the first case in which health insurance coverage has been applied to a combination therapy involving new drugs developed by different pharmaceutical companies.
Based on this case, the MOHW plans to pursue institutional improvements to expand health insurance coverage for combination therapies involving different new drugs.
Second Vice Minister Lee Hyung-hoon of the MOHW said, "I hope this expansion of health insurance coverage will ease the burden on patients and their families who have delayed or given up treatment because of high drug costs." He added, "We will continue working to strengthen health insurance coverage for treatments for rare and severe diseases."

[email protected] Jeong Sang-hee Reporter