The Ministry of Health and Welfare held a Health Insurance Policy Deliberation Committee meeting on the 25th to discuss plans to expand insurance coverage for immunotherapy drugs, overhaul payment rates for rehabilitation medical institutions, and promote the re-evaluation and reclassification of medical services. The idea is to pursue both expanded coverage and stronger post-management at the same time.
◇ Immunotherapy to apply to bile duct cancer as well… up to 580 billion won to be invested in intensive rehabilitation
Starting Mar. 1, the National Health Insurance coverage for the immunotherapy drug "Imfinzi injection (durvalumab)" will be expanded to bile duct cancer. Until now, the drug was reimbursed only for Non-small cell lung cancer (NSCLC).
No new treatments have been listed for bile duct cancer over the past 10 years. The government expects the expanded coverage to broaden treatment options and extend survival.
Out-of-pocket costs will drop significantly when coverage applies. Previously, patients had to pay the full annual drug cost of about 118,930,000 won, but with a 5% coinsurance rate applied, the annual burden per patient is expected to fall to about 5,950,000 won.
A pilot program to strengthen payment rates for recovery-phase rehabilitation will also be expanded. The government designated 71 phase-3 rehabilitation medical institutions (13,390 beds) and will apply a new payment system starting in Mar.
It will provide team-based, multidisciplinary intensive rehabilitation for patients who need functional recovery after acute-phase treatment. Instead of unit rates for individual therapies, similar specialized therapies will be bundled and calculated in 15-minute units, recognizing up to 4 hours (16 sessions) per day.
Eligible patients include those with central nervous system diseases such as stroke and spinal cord injury; hip and femoral fractures and arthroplasty; lower-limb amputation; and disuse syndrome. Depending on the patient group, intensive rehabilitation will be provided within 30, 60, or 180 days, and the inpatient fee reduction system will not apply during this period.
After intensive rehabilitation, patients will be connected to post-discharge care through integrated plan management fees and community linkage fees. For patients who need home care, home-based rehabilitation therapy will also be provided.
From 2025 to 2027, an estimated 520 billion to 580 billion won will be invested in the four-stage pilot program for payment rates. The government also plans to introduce a system of differential compensation based on the level of functional recovery and outcomes of return to the community.
◇ 7,760 medical services to be re-evaluated… substitute technologies could be "phased out"
The government will also revamp the post-management system for about 7,760 medical service items listed under National Health Insurance. There had been criticism that mechanisms to re-evaluate changes in safety and efficacy after listing were insufficient.
Accordingly, it will codify the medical technology re-evaluation system (to take effect in Sept. 2025) and consider measures to adjust compensation levels or exclude items from coverage based on the evaluation results. Items that have been replaced by new technologies or whose clinical value has declined will be targeted for overhaul.
In addition, it will establish a comprehensive reclassification framework for areas where difficulty or resource consumption has not been adequately reflected, such as rare disease care and pediatric and highly complex surgeries. It plans to shift from partial revisions every four to seven years to a regular, comprehensive reclassification system.
To this end, a "task force for re-evaluation and reclassification of medical services" will be formed under the Health Insurance Policy Deliberation Committee. The Director General of Health Insurance Policy and experts will serve as co-Director Generals, with relevant departments of the ministry, HIRA, and the National Evidence based Healthcare Collaborating Agency (NECA) participating.
The ministry said, "We will provide appropriate compensation for useful medical services through ongoing adjustments to relative values, and we will streamline technologies whose value has changed by reducing compensation or excluding them from coverage."