"Shall I give you Onyoupecia (a type of hair-loss drug)?"
On the 22nd, around Jongno 5-ga in Jongno-gu, Seoul. Even on a weekday morning, patients kept streaming into hospitals and pharmacies known as the so-called "holy land of hair-loss and weight-loss drugs." Before the patient even sat down in the doctor's office, the prescription was issued. When the patient nodded, the response came back, "You may go." It was over in five seconds. Even counting from registration to payment, it took less than two minutes.
Office worker A, in their 30s, who said it was their first time visiting this hospital, said, "I came early because I thought it would get more crowded if health insurance is applied," and added, "I came as a preventive measure, but I didn't expect the prescription to come out this easily." The "speed prescription" was the same at another hospital said to mainly prescribe weight-loss drugs.
After President Lee Jae-myung ordered a review of applying health insurance to hair-loss and weight-loss drugs, expectations and concerns have been mixed on the ground. Some say it is necessary to provide coverage at the prevention and treatment stages by viewing hair loss and obesity as diseases, while many point out that in a situation already under fire for overprescribing, this could only increase the burden on the health insurance budget.
◇"They are diseases, but standards are needed"… public reaction is split
The spark for this discussion came from the president's remarks. On the 16th, at a Health and Welfare Ministry briefing, he ordered a review of applying health insurance coverage to hair-loss and weight-loss drugs. The president also pledged during the 20th presidential election to provide coverage for hair-loss treatments.
Currently, alopecia areata caused by autoimmune disease is classified as an immune disease, and health insurance applies to treatments such as steroids. However, treatment for hair loss due to aging or genetic factors is not covered.
For obesity treatment as well, insurance applies to surgical treatment for severe obesity, but drug therapies in the glucagon-like peptide-1 (GLP-1) class, such as Wegovy or Mounjaro, remain uncovered.
A survey of pharmacies around Jongno 5-ga that day found that a month of weight-loss medication cost about 300,000–500,000 won depending on the dosage. Hair-loss drugs varied widely depending on whether they were generics and on the manufacturer, but came to 100,000–500,000 won per year.
Public reaction to applying insurance coverage was divided. Park, a 28-year-old office worker who said they are taking medication to prevent hair loss, said, "Both hair loss and obesity are more meaningful at the prevention stage than treating after they have already progressed," adding, "Even partial coverage would reduce the burden."
On the other hand, Lee, 32, who is receiving a prescription for a weight-loss drug, said, "We need clear standards to distinguish cosmetic purposes from treatment purposes," and added, "It is realistic to apply coverage only in limited cases that meet medical criteria such as BMI (body mass index)."
◇"Overprescribing will increase"… concerns about health insurance deficits
The problem is that there is already considerable controversy over overprescribing. If the expense burden decreases, prescriptions are likely to increase further. Lee, a 34-year-old office worker, said, "(For both hair-loss and weight-loss drugs) there are already issues with misuse and overuse, and if they are covered by insurance, people will try to take them more easily and in larger amounts."
Among pharmacists, many said this would lead to a worsening of the health insurance finances and higher premiums. A pharmacist surnamed Kim working at a pharmacy in Jongno 5-ga said, "With the coverage burden for cardiovascular diseases and adult diseases growing due to aging, it is not realistic to support treatments for cosmetic purposes among younger people with health insurance," adding, "In the end, it will be hard to manage without raising premiums."
The Korea Institute for Health and Social Affairs (KIHASA) projects that even if the health insurance premium rate is raised to the legal ceiling of 8%, by 2050 total expenditure will reach 296.4 trillion won and total revenue will be only 251.8 trillion won, resulting in an annual fiscal shortfall of about 44.6 trillion won.
Assuming Korea's hair-loss population is about 10 million and the obese population is 18 million, and half of them become eligible for coverage with the insurance burden rate at 70%, the annual health insurance fiscal requirement is estimated to reach about 24 trillion won.
Lee, a pharmacist in their 30s, said, "With weight-loss drugs, stopping them often leads to the yo-yo effect, which can result in long-term or lifelong use," adding, "Recognizing drugs for cosmetic purposes as covered benefits does not align with the principles of the system."
◇Government says it will "review the fiscal impact comprehensively"… overseas also have 'limited application'
The government is cautious. Health and Welfare Minister Jung Eun-kyeong, appearing on a radio program on the 17th, was asked by the host, "If health insurance is applied to genetic hair loss, do you think it would significantly affect the health insurance finances?" She said, "I think it would," and added, "We plan to comprehensively analyze and review how it will affect the health insurance finances."
Overseas, there are cases where insurance coverage is applied to weight-loss drugs on a limited basis. In Japan, only some weight-loss drugs are included in health insurance coverage for people with a BMI of 35 or higher, or a BMI of 27 or higher with at least two obesity-related health problems such as hypertension, dyslipidemia, or type 2 diabetes.
However, in the case of weight-loss drugs, some analysis suggests there could be a virtuous cycle in which applying health insurance reduces the overall medical expense burden. Nam Ga-eun, a family medicine professor at Korea University Guro Hospital, said in a report on future innovation strategies for the pharmaceutical and bio industries, "Short-term fiscal burdens are inevitable, but by reducing complications, we can expect medical cost savings in the mid to long term."