South Korea’s National Health Insurance Service (NHIS) is preparing to expand its coverage of prescription drugs, with a particular focus on oncology treatments, according to a statement released by the Ministry of Health and Welfare on February 26, 2026. While the proportion of health insurance spending allocated to pharmaceuticals has been decreasing in recent years, it remains the largest single component of the national health insurance fund’s expenditures.
Drug costs accounted for 33.41% of total health insurance spending in 2022, amounting to 40.10 trillion Korean won. This figure decreased slightly to 32.82% (45.84 trillion won) in 2023, and further to 31.22% (50.78 trillion won) in 2024. The NHIS stated that these trends underscore the demand for rational drug selection, utilization, and payment to ensure the efficiency of the health insurance fund and reduce out-of-pocket expenses for citizens.
Current regulations governing pharmaceutical coverage for NHIS beneficiaries are based on Ministry of Health and Welfare Ordinance No. 20/2022/TT-BYT, which came into effect on March 1, 2023. The ordinance encompasses 1,037 active ingredients, chemical drugs, and biological agents, categorized into 27 major groups, along with 59 radiopharmaceuticals and tracers. Yet, the list largely mirrors a 2018 directive (Official Document No. 30/2018/TT-BYT), with only minor updates for certain COVID-19 treatments and expanded access to some drugs at local health centers.
The proposed revisions include the addition of 84 new drugs to the national formulary. A significant portion of these additions – 30, or 35.7% – are anti-cancer drugs, including targeted therapies, monoclonal antibodies, and immune-oncology agents. According to the NHIS, this expansion will provide physicians with more treatment options, improve access to advanced therapies, and reduce the financial burden on cancer patients. Currently, the NHIS covers 81 drugs within the cancer treatment and immunomodulatory drug groups.
Beyond oncology, the draft guidelines also propose adding 24 new drugs for the treatment of chronic diseases such as cardiovascular disease, diabetes, respiratory illnesses, mental disorders, and urinary diseases, representing 29% of the proposed additions. Eighteen of the 84 new drugs (21.4%) are designated for the treatment of rare diseases, with 14 of those also being anti-cancer agents. The NHIS noted that treatments for rare diseases, cancer, and chronic conditions often involve lengthy and costly care pathways.
The Ministry of Health and Welfare has instructed the NHIS to carefully review and revise Ordinance No. 20/2022/TT-BYT, in collaboration with relevant departments, to reflect current treatment needs and medical advancements. The revisions also include modifications to the conditions and reimbursement rates for 52 existing drugs, with many seeing expanded coverage and increased reimbursement levels.
The NHIS stated that the addition of drugs, particularly expensive cancer treatments, will be carefully evaluated based on their budgetary impact and appropriate reimbursement rates will be established to ensure the financial sustainability of the health insurance fund. The proposed changes also align with policies aimed at improving the quality and efficiency of local health centers by expanding the list of drugs available at the community level, potentially reducing the need for patients to travel to larger medical facilities.
According to the NHIS, the draft guidelines, including two appendices detailing chemical and biological drugs, as well as radiopharmaceuticals and tracers, are nearing completion. The Ministry of Health and Welfare plans to convene expert consultations for each drug category to finalize details regarding new drug additions, coverage conditions, and reimbursement rates. The guidelines are expected to be published and implemented in 2026.
