As the possibility of health insurance coverage for the abortion pill has been raised to reduce the financial burden on women who urgently need abortions, obstetricians and gynecologists have pushed back.
Their argument is that legal standards and safety systems must be established before pursuing insurance coverage. Meanwhile, in the National Assembly, even the "ex officio listing" system for rapid health insurance application has been mentioned, raising expectations of controversy.
On the 22nd, Kim Jae-yeon, president of the Korean Society of Obstetrics and Gynecology, criticized the situation in a phone interview with reporters, stating, "Discussing insurance coverage before establishing the standards that should be set by law and the medical safety system is a reversal of priorities."
Previously, at the National Audit on the 7th by the Health and Welfare Committee of the National Assembly, Nam In-soon, a member of the Democratic Party of Korea, requested Ministry of Health and Welfare Jeong Eun-gyeong (Minister) to "review the ex officio listing of pregnancy termination drugs under health insurance by the Minister of Health and Welfare." Ex officio listing in health insurance refers to the process where the Minister of Health and Welfare includes specific drugs, medical procedures, or treatment materials in the health insurance coverage list on their own authority if legal requirements are met, even if pharmaceutical companies or medical device manufacturers have not applied for such coverage. This is why it is often called a "fast pass" for health insurance application.
In response, Ministry of Health and Welfare Minister Chung Eui-kyung stated, "Regarding ex officio listing, we need to consider the legal requirements," adding, "We must also consider fairness with other drugs." It is reported that the pharmaceutical company has not yet applied for health insurance coverage for 'Mifegymiso,' the pregnancy termination drug that the government recently decided to introduce. The Ministry of Health and Welfare stated that it will actively review insurance coverage once the pharmaceutical company submits an application.
Nam (Rep.) pointed out that in Japan in 2023, when pregnancy termination drugs were introduced, low utilization rates resulted because health insurance did not cover them, suggesting that financial burdens could similarly reduce accessibility domestically. They added, "We hope you will not leave it solely to the (insurance) application by pharmaceutical companies," urging, "Please actively review options for health insurance coverage, including ex officio listing by the Minister."
However, obstetricians and gynecologists maintain that insurance coverage is not an urgent matter. The Korean Society of Obstetrics and Gynecology issued a statement on the 21st, noting, "Insurance coverage is not simply about reducing the burden of drug costs; it is a decision by the state to publicly recognize the scope and standards of the medical procedure," adding, "That decision must be made based on laws and safety standards."
Currently, health insurance for pregnancy termination (abortion surgery) applies only in cases where it is necessary for maternal health or involves rape, etc., under Article 14 of the Mother and Child Health Act. Kim (Chairman) stated, "We do not oppose continuing to apply insurance coverage to pregnancy termination based on current medical and legal grounds," but pointed out that "expanding insurance coverage to include pregnancy termination without questioning the grounds is deciding in advance through administrative procedures matters that should be determined by the National Assembly."
Furthermore, the medical association takes the position that safety should be assessed first before pushing for insurance coverage, given that pregnancy termination drugs are classified as "high-risk specialized pharmaceuticals." Kim (Chairman) warned, "If ultrasound is not used to confirm intrauterine pregnancy and gestational age before administering pregnancy termination drugs, ectopic pregnancies may be missed, leading to rupture and massive hemorrhage." In fact, according to U.S. Food and Drug Administration (FDA) approval details, in clinical trials within the United States, 2.6% of those who took pregnancy termination drugs required surgical intervention, and 2.9% to 4.6% were transported to emergency rooms.
Kim (Chairman) emphasized, "If incomplete miscarriage, bleeding, or infection occurs after taking pregnancy termination drugs, immediate surgical procedures such as dilation and curettage and emergency medical care must follow," adding, "Discussing insurance coverage before establishing standards for in-person consultations, ultrasound diagnosis, emergency linkage, and post-procedure follow-up is putting the cart before the horse."
The medical association also urged the government to officially include obstetrician and gynecologist expert groups in the process of setting safety usage standards. Kim (Chairman) stated, "We are not against the introduction of pregnancy termination drugs themselves; rather, we are advocating for establishing legal standards and safety systems first to protect women's lives and safety," adding, "We will actively participate in National Assembly legislative discussions to ensure that a system with such standards is established."
in THEBIO
