Japan’s health insurance to cover new cancer therapy that costs ¥33 million


A government panel on Wednesday approved coverage of a new therapy to treat leukemia and other hematologic cancers, which currently costs ¥33.49 million ($305,000), under national health insurance, in a move that would significantly ease the burden on patients.

The drug Kymriah will be produced and sold by Novartis Pharma KK, a Tokyo-based unit of Swiss pharmaceutical giant Novartis AG, and is expected to carry the highest price tag of any single drug in Japan. Coverage is set to be available from May 22.

But the decision by the health ministry panel may raise concerns about the impact on the country’s ballooning medical care costs as Japan’s population rapidly grays.

The one-time therapy, which works by genetically modifying a patient’s immune cells so that they launch an all-out attack on the disease, is considered effective on patients for whom existing treatments do not work.

Under the nation’s public health insurance system, a policyholder usually shoulders around 10 percent to 30 percent of the cost incurred at medical institutions, with the remaining amount covered by the policy in exchange for monthly premiums.

There is also a cap on monthly medical payments depending on a policyholder’s income. For example, a patient with an annual income of between ¥3.7 million and ¥7.7 million would have to shoulder costs of roughly ¥410,000 a month in order to be treated with Kymriah. The Health, Labor and Welfare Ministry estimates that the number of patients eligible to use the drug will total 216 a year at most, and will generate an annual revenue of ¥7.2 billion.

Clinical tests of Kymriah, including those involving Japanese patients, have shown that around 80 percent of those suffering from leukemia and some 50 percent of those with lymphoma saw significant improvements in symptoms.

Those eligible to use the drug include children, those 25 or younger with B-cell precursor acute lymphoblastic leukemia and patients of any age with diffuse large B-cell lymphoma, who are not able to be cured using other anti-cancer drugs.



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