Starting this month, national health insurance coverage will apply to the glucagon-like peptide-1 (GLP-1) class diabetes treatment Ozempic Pre-filled Pen (ingredient semaglutide) for people with type 2 diabetes.
Type 2 diabetes is a chronic disease in which blood sugar is not controlled due to insulin resistance. Ozempic is the only approved GLP-1 therapy that has been recognized not only for lowering blood sugar in people with type 2 diabetes but also for reducing the risk of major cardiovascular diseases such as myocardial infarction and stroke, as well as chronic kidney disease.
According to the Ministry of Health and Welfare and Novo Nordisk Pharma on the 3rd, for patients whose hemoglobin A1c remains 7% or higher even after 2 to 4 months of combination therapy with the existing diabetes treatments metformin and sulfonylureas, and whose body mass index (BMI) is 25 kg/㎡ or higher or who cannot undergo basal insulin therapy, the combination regimen using the three agents Ozempic, metformin, and a sulfonylurea has been covered since the 1st.
If significant blood sugar improvement is achieved with the three-drug combination therapy, coverage also applies to the two-drug combination therapy with Ozempic and metformin. The conditions are: ▲ hemoglobin A1c of 7% or higher even after 2 to 4 months of basal insulin alone or in combination with metformin, or ▲ hemoglobin A1c of 7% or higher even with combination therapy of Ozempic and metformin (± sulfonylurea).
At initial administration, in accordance with the coverage criteria for the target population, treatment history and hemoglobin A1c test results must be submitted, or the BMI result must be recorded in a specific field on the claim form. Thereafter, during maintenance therapy, hemoglobin A1c is evaluated every three months.
For a single prescription period, in the first three months when dose adjustment is required according to the approval conditions, up to a 4–6 week supply is recognized. Thereafter, up to a three-month supply is recognized. However, when switching from another GLP-1 agent in the same class to Ozempic, coverage for Ozempic is recognized if the patient's condition at the time of the initial GLP-1 administration meets the current coverage criteria.
Kim Sung-rae, president of the Korean Diabetes Association (Division of Endocrinology and Metabolism, Bucheon St. Mary's Hospital, The Catholic University of Korea), said, "In recent years, treatment for type 2 diabetes has shifted from simple blood sugar control to a personalized approach that also considers overall complication risk and long-term outcomes," adding, "Coverage for Ozempic is meaningful in that it expands the treatment options that can be selected to match actual patient characteristics."