Starting from April, the anti-cancer drug "Enhertu 100mg" will be covered by health insurance for breast cancer and gastric cancer patients

Starting Apr.1 2024, the health insurance coverage will be applied to the treatment drug "Enhertu 100mg (active ingredient: trastuzumab deruxtecan)" for metastatic breast cancer and gastric cancer patients. The Ministry of Health and Welfare approved the "Revision of the Drug Benefit List and Maximum Reimbursement Price(MRP) List" containing these contents at the Health Insurance Policy Deliberation Committee held at Health Insurance Review and Assessment Service (HIRA) on the 28th. March.

The MRP for Enhertu 100mg (manufactured by Daiichi Sankyo) newly included in insurance from April is 1,431,000KRW (1,061USD)

The health insurance coverage applies to patients with "metastatic breast cancer and gastric cancer who are HER2 positive and have previous treatment experience."

With the listing of the new drug in reimbursement, it provides a new treatment option for HER2-positive metastatic breast cancer and gastric cancer patients, reducing their economic burden.

HER2-positive metastatic breast cancer patients used to bear an annual medication cost of about 83 million KRW (61K USD) per person, but with the application of health insurance this time, they will bear about 4.17 million KRW (3100 USD). This is due to the application of a 5% co-payment based on breast cancer criteria.

In the reimbursement and total amount limitation methods, the pharmaceutical company must reimburse a certain percentage of the drug's claims amount to HIRA. Additionally, if the annual claims amount of the drug exceeds the predetermined annual expenditure amount, the pharmaceutical company must reimburse a certain percentage of the excess amount to HIRA.

The Ministry of Health and Welfare stated, "We plan to expand health insurance coverage for drugs determined through the revision of the Drug Benefit List and MRP list from April 1st."