Korea Faces Diabetes Drug Coverage Debate as Complication Care Costs 394.1 Billion Won

A costly gap in the diabetes coverage debate

South Korea's National Health Insurance Service paid 394.1 billion won for care involving 601,063 people with serious diabetes complications in 2025. Yet the Ministry of Health and Welfare has no analysis of how much earlier treatment with newer diabetes medicines might save by preventing complications, according to information disclosed by Rep. So Byeong-hoon on October 2, 2026.

The figures put a concrete price on a reimbursement debate involving tirzepatide, sold as Mounjaro, and semaglutide, sold as Ozempic. Both medicines can improve blood glucose control. Evidence also supports cardiovascular or kidney benefits for some medicines and patient groups, although those findings cannot be treated as identical across drugs or as proof that broader coverage would pay for itself.

The question is becoming more pressing because reimbursement reviews have already moved forward. Mounjaro received a positive assessment from the Health Insurance Review and Assessment Service (HIRA) in December 2025, while Ozempic passed committee review that October. Those steps are distinct from a final decision establishing prices, eligibility and the start of insurance coverage.

So, a Democratic Party of Korea lawmaker representing Gwangju in Gyeonggi Province and a member of the National Assembly Health and Welfare Committee, is calling for reimbursement criteria for patients whose diabetes cannot be adequately controlled with existing medicines. His criticism concerns a missing fiscal assessment, not an established finding that newer drugs would reduce total spending.

What the 2025 spending figures show

Data submitted to So by the NHIS, the health ministry and HIRA recorded 3,731,549 people receiving treatment for type 2 diabetes in 2025. The diagnosis was identified by code E11, the classification used for type 2 diabetes in the figures.

Total medical expenses reached 3.4996 trillion won, approximately $2.57 billion using the conversion accompanying the figures. The NHIS covered 2.4382 trillion won, or about 69.7 percent of that total. The difference between total expenses and the insurer's contribution should not automatically be treated as a measure of all costs paid directly by patients.

The 601,063 patients treated for major complications represented about 16.1 percent of the recorded diabetes population, roughly one in six. The complications named in the disclosure included diabetic foot ulcers, kidney complications and retinopathy, which affects the retina and can damage vision.

The 394.1 billion won paid for their care, approximately $289 million, was equivalent to about 16.2 percent of the NHIS's 2.4382 trillion won contribution to type 2 diabetes treatment. Dividing the complication figure by the number of affected patients gives an annual average of roughly 655,000 won per person.

That average is a description of spending across the recorded group, not the price of treating an individual ulcer, a course of dialysis or a particular eye condition. It also does not establish how much spending could be avoided through a different treatment policy. The disclosure does not provide a breakdown by complication, severity or treatment.

The ministry has not calculated potential savings

So's office asked the Ministry of Health and Welfare for an analysis of medical costs that could be saved by preventing diabetes complications through earlier drug treatment. The ministry responded that it had no such analysis data. It also said estimating the fiscal cost of insurance coverage for the medicines was difficult.

Those are two connected gaps. Without a forecast of how many patients would qualify, what medicines would cost and how treatment patterns would change, the government cannot establish the additional drug bill. Without an estimate of complications prevented over time, it cannot establish the potential offsetting savings either.

So argued that the government should assess spending over the medium and long term, given that roughly 600,000 patients receive complication care annually. He called for prompt reimbursement criteria for severe diabetes that remains inadequately controlled with existing treatments such as metformin, while maintaining strict controls on use for cosmetic purposes outside insurance coverage.

The distinction matters for the policy debate. A proposal aimed at patients with difficult diabetes is different from unrestricted reimbursement for weight loss. Eligibility would determine both who gains access and how large the insurance commitment becomes.

Reimbursement reviews have already advanced

The absence of a fiscal savings analysis does not mean the medicines have never entered Korea's reimbursement process. Eli Lilly Korea submitted an application for Mounjaro for its diabetes indication, and by August 22, 2025, it was proceeding toward review by HIRA's Drug Reimbursement Evaluation Committee.

On December 4, 2025, HIRA announced that Mounjaro Prefilled Pen was suitable for reimbursement as an addition to diet and exercise to improve blood glucose control in adults with type 2 diabetes. Ozempic had passed committee review in October 2025 and was described as being in price negotiations with the NHIS.

The sequence separates several developments that can otherwise become blurred:

• August 22, 2025: Mounjaro's reimbursement application was reported to be progressing toward HIRA committee review.
• October 2025: Ozempic passed reimbursement committee review.
• December 4, 2025: HIRA judged Mounjaro suitable for reimbursement for adult type 2 diabetes care alongside diet and exercise.
• October 2, 2026: So disclosed the 2025 treatment and spending figures and the ministry's response about the missing savings analysis.

A positive committee assessment is not the same as confirmation that patients can obtain a medicine under finalized insurance terms. The December 2025 account left the timing of final reimbursement decisions for both drugs uncertain. The October 2026 disclosure does not establish their subsequent negotiation status, final prices or a coverage commencement date.

What the treatment evidence establishes

Mounjaro is a weekly injection that acts on receptors for two hormones, GIP and GLP-1, involved in blood glucose regulation. Ozempic acts on the GLP-1 receptor. These medicines help regulate glucose through mechanisms that include supporting insulin release and influencing digestion and appetite.

The account of Mounjaro's application described five SURPASS Phase III trials involving 6,278 participants. Across the trial program, comparisons included placebo, semaglutide, insulin degludec and insulin glargine. Tirzepatide improved HbA1c compared with the relevant control treatments and starting levels.

HbA1c is a blood test reflecting average glucose levels over roughly the preceding two to three months. It helps assess whether treatment is controlling diabetes beyond the fluctuations captured by a single glucose reading. Better HbA1c results support a medicine's role in glucose management, but they are not themselves a calculation of hospital costs avoided.

The distinction is essential when using clinical results to support reimbursement. A medicine may improve glucose control without an economic analysis yet showing how those improvements translate into fewer complications, longer treatment duration or lower insurance spending in Korea.

Cardiovascular findings require careful interpretation

The reimbursement application account also described results from SURPASS-CVOT, a cardiovascular outcomes trial comparing Mounjaro with Trulicity, the brand name for dulaglutide. Mounjaro met the trial's primary endpoint by demonstrating noninferiority for a combined measure of cardiovascular death, heart attack and stroke.

Noninferiority means a treatment met the study's predefined standard for not being unacceptably worse than its comparator. It does not, by itself, establish that Mounjaro prevented more of those events than Trulicity. The comparator was another active medicine, not an absence of diabetes treatment.

The trial account also described improvements in HbA1c, weight, kidney function and mortality from all causes, but did not provide the detailed effect sizes or statistical results needed here to quantify those findings. They therefore cannot support a numerical estimate of Korean insurance savings.

The broader evidence cited in the coverage debate indicates cardiovascular and kidney benefits for some newer medicines and patient groups. That does not establish equal protection against every complication named in the Korean spending data. Foot ulcers, kidney disease and retinopathy have different clinical outcomes, and each requires evidence appropriate to the drug and patients being considered.

Other countries offer conditional access

HIRA's information submitted to So pointed to public reimbursement arrangements or recommendations involving Britain's National Institute for Health and Care Excellence, Australia's Pharmaceutical Benefits Advisory Committee and Canada's Drug Agency, CDA-AMC. These concern tirzepatide or semaglutide for certain patients with type 2 diabetes, subject to each country's criteria.

The international comparison supports the case for examining defined patient groups rather than treating coverage as an unrestricted choice. The Korean disclosure describes access for some patients whose glucose is not adequately controlled with existing medicines.

It does not establish that all three countries reimburse both medicines on identical terms. Nor does it provide their negotiated prices, the exact restrictions for each product or an estimate that could be transferred directly to Korea.

For Korean policymakers, the useful comparison is the existence of routes to conditional access. Whether a particular arrangement is affordable locally would still depend on Korea's eligible population, treatment choices, prices and expected health outcomes.

Why complication spending is not a savings forecast

The 394.1 billion won figure supplies a starting point for discussion, but it is not a pool of spending that newer drugs could necessarily eliminate. Some patients already have established complications. Others may require care despite improved glucose control, and the reported total does not separate preventable future events from treatment of existing disease.

There is also a difference between an effective treatment, a treatment that represents good value and a treatment that saves money. Better health outcomes may justify additional spending without reducing the insurer's total bill. A claim of net savings requires evidence that avoided costs exceed the added costs of treatment over a defined period.

A useful assessment would need to specify who qualifies, the negotiated medicine price, how long patients remain on treatment and which existing medicines are replaced or continued. It would then need to estimate reductions in specific complications and the timing of those reductions. These are analytical requirements, not figures established by the disclosure.

The spending totals explain why So is pressing for that work. The insurer already contributes more than 2.4 trillion won annually to care for the recorded type 2 diabetes population, while treatment involving serious complications accounts for hundreds of billions of won. Even so, those totals alone cannot resolve which reimbursement rules would produce the best balance of access, health benefits and expenditure.

No date is given for completion of a government savings analysis, publication of final eligibility rules or the start of coverage for either medicine. The unresolved issue is therefore both clinical and fiscal: how to identify patients most likely to benefit, and how to measure the cost of treating them against the cost of complications that might be prevented.

Key Points

• Korea recorded 3,731,549 patients receiving type 2 diabetes treatment in 2025, with medical expenses of 3.4996 trillion won.
• The NHIS paid 2.4382 trillion won toward that care, including 394.1 billion won for patients with major complications.
• The 601,063 patients treated for complications represented approximately one in six recorded diabetes patients.
• The health ministry said it had no analysis of potential savings from earlier preventive drug treatment and that coverage costs were difficult to estimate.
• Ozempic passed committee review in October 2025; Mounjaro received a positive reimbursement assessment on December 4, 2025.
• Clinical benefits do not automatically establish net insurance savings, and final coverage terms and commencement dates are not established by the disclosures.