The landscape of cancer treatment is swiftly evolving towards combination therapies involving new drugs; however, significant barriers remain in achieving insurance coverage. Experts have pointed out that the current healthcare system, designed around single-drug therapies, is inadequate for evaluating the value of combination treatments. As a result, the advancement in insurance coverage for therapies that combine drugs from different manufacturers has been stagnant. According to Professor Lee Hangil from Ewha Womans University, there have been no instances of new drug combination therapies being covered under insurance, particularly when drugs from different companies are involved.

In the past decade, 71 combination therapies have been introduced in South Korea, with 21 of them (30%) involving immunotherapy and targeted drugs. While the government has applied partial coverage to 35 of the 54 combination therapies started since June last year, these have included combinations that involve existing chemotherapy drugs rather than those from distinct new drug manufacturers. This presents a critical gap in patient access to innovative treatment methods that could be more effective when combined, further aggravating the issue of insurance inadequacies.

Two main issues have been identified as hindrances to resolving this situation: the limitations of the current price evaluation system and anti-collusion regulations in fair trading law. The structure for drug pricing and evaluation is fundamentally centered around single-agent therapies, making it challenging to assess the therapeutic value of each component in combination therapies and their synergistic effects. Additionally, the Fair Trade Act raises concerns about pharmaceutical company collaborations potentially being viewed as collusion, creating legal risks that deter necessary discussions between companies on how to negotiate drug prices and value distribution for combination therapies.