Korea has unveiled major reforms to its national health insurance drug pricing system to improve patient access to innovative medicines, especially for severe and rare diseases. Several weeks ago, the government submitted its “Proposal for Improving the Drug Pricing System” to the Health Insurance Policy Deliberation Committee (HIPDC), focusing on raising and facilitating the better use of the Incremental Cost-effectiveness Ratio (ICER) threshold.
While Korea does not officially publish its ICER benchmark, the government acknowledged that its long-standing implicit threshold is outdated and no longer reflects advances in medical technology. Authorities plan to review and raise the threshold to a more realistic level. A detailed framework is expected after a policy study is completed by 2027.
In addition, the reform introduces a new weighted ICER model that adjusts reimbursement decisions based on disease severity, therapeutic value, and budget impact. In the long term, Korea will adopt a “fast-track listing and post-evaluation” approach, which allows high-value drugs to be reimbursed earlier while adjusting prices later using real-world data.
Recent reimbursement approvals for Enhertu (Daiichi Sankyo), Trodelvy (Gilead), and Imfinzi (AstraZenaca) under flexible ICER criteria highlight the policy direction. The new proposal aims to make such flexibility more systematic to accelerate access to breakthrough therapies for Korean patients with limited treatment options.
Written by: Ames Gross – President and Founder, Pacific Bridge Medical (PBM)
Mr. Gross founded PBM in 1988 and has helped hundreds of medical companies with regulatory and business development issues in Asia. He is recognized nationally and internationally as a leader in the Asian medical markets. Mr. Gross has a BA degree, Phi Beta Kappa, from the University of Pennsylvania and an MBA from Columbia University.