- Date2025-04-23
Publication of Review Result of the 1st Serious Illness (Cancer) Review Committee of 2025
□ The Health Insurance Review and Assessment Service (President Kang Jung-Gu) releases the result of the deliberations of the 1st Cancer Review Committee in 2025 on ‘Reimbursement criteria for drugs used for cancer patients (Improvement of reimbursement standards reflection clinical reality)’ as follows.
○ New pharmaceutical (application for determination of health insurance coverage) and expansion of reimbursement standards
|
Category |
Product |
company |
Efficacy and effectiveness |
Deliberation results | |
|
Application for healthcare benefit reimbursement |
ortumab Vedotin)
|
Astellas Pharma Inc Korea |
Combined modality therapy with pembrolizumab as primary treatment for an adult patient contracting topically advanced or metastatic urothelial carcinoma |
To be discussed again | |
|
Elrexfio Inj. (Elranatamab) |
Pfizer Korea |
Single therapy for an adult patient contracting relapsed or refractory multiple myeloma who received more than tertiary treatment inculding a pembrolizumab inhibitor, an immunomodulatory drug, and daratumumab |
To be discussed again | ||
|
Vyloy Inj. (Zolbetuximab) |
Astellas Pharma Inc Korea |
factor Receptor 2 protein)-negative |
To be discussed again | ||
|
Expand reimbursement scope |
Scemblix Tab (Asciminib Hydrochloride) |
Novartis Korea |
Therapy for an adult patient contracting Philadelphia chromosome positive chronic myeloid leukemia (Ph+ CML) in chronic phase, who received more than two tyrosine kinase inhibitors (TKI) |
Reimbursement criteria to be established | |
(Methotrexate) |
Pfizer Korea etc |
Non-Hodgkin’s lymphoma (NHL) |
(Intraocular lymphoma) | ||
|
Keytruda Inj. (Pembrolizumab) |
Korea MSD |
|
Reimbursement criteria to be established | ||
|
Keytruda Inj. (Pembrolizumab) |
Korea MSD |
factor Receptor 2 protein)-negative |
Reimbursement criteria to be established (CPS≥10) | ||
|
Keytruda Inj. (Pembrolizumab) |
Korea MSD |
factor Receptor 2 protein)-negative |
Reimbursement criteria to be established | ||
|
Keytruda Inj. (Pembrolizumab) |
Korea MSD |
high (MSI-H) or mismatch repair deficient (dMMR) |
Reimbursement criteria to be established | ||
|
Keytruda Inj. (Pembrolizumab) |
Korea MSD |
The treatment for a patient contracting colorectal cancer (CRC) which is unresectable or metastatic, with MSI-H or dMMR |
Reimbursement criteria to be established | ||
|
Keytruda Inj. (Pembrolizumab) |
Korea MSD |
Positive Score (CPS)≥1); and ii) combined modality therapy with 5-FU. platinum-based chemotherapy |
Reimbursement criteria to be established | ||
|
Keytruda Inj. (Pembrolizumab) |
Korea MSD |
Combined modality therapy with Bevacizumab included or not chemotherapy, as the treatment for a patient contracting persistent, recurrent or metastatic cervical cancer, with PD-L1-positive (CPS≥1) |
Reimbursement criteria to be established | ||
|
Keytruda Inj. (Pembrolizumab) |
Korea MSD |
with PD-L1-positive (CPS≥10) |
Reimbursement criteria to be established | ||
|
Keytruda Inj. (Pembrolizumab) |
Korea MSD |
Treatment for a patient contracting unresectable, metastatic solenoma, which was found developing after prior treatment, without satisfactory alternatives, and with MSI-H or dMMR |
Reimbursement criteria to be established | ||
|
Keytruda Inj. (Pembrolizumab) |
Korea MSD |
Treatment for a patient contracting unresectable, metastatic small intestine cancer, which was found developing after prior treatment, without satisfactory alternatives, and with MSI-H or dMMR
|
Reimbursement criteria to be established | ||
|
Keytruda Inj. (Pembrolizumab) |
Korea MSD |
Treatment for a patient contracting unresectable, metastatic bile duct cancer, which was found developing after prior treatment, without satisfactory alternatives, and with MSI-H or dMMR
|
Reimbursement criteria to be established |
* Pursuant to Article 5 and Article 5.2 of the Rules on the Criteria for National Health Insurance Reimbursement, the President of the Health Insurance Review and Assessment Service may notify the details of the reimbursement criteria and methods for drugs prescribed and administered to seriously ill patients that are designated and notified by the Minister of Health and Welfare after deliberation by the Serious Illness Review Committee. The reimbursement criteria for such drugs may be set differently according to clinical literature, domestic and foreign guidelines, and expert opinions within the scope of efficacy and effectiveness of the Ministry of Food and Drug Safety approval, and the reimbursement decision and criteria may change in the course of subsequent process.
