Health Insurance Coverage Expanded for Severe Alopecia Areata Treatment

The government is significantly expanding health insurance coverage for treatments used by adult patients with severe alopecia areata.

The Ministry of Health and Welfare announced today (June 19) that it has issued a partial amendment to the criteria for health insurance benefits regarding oral baricitinib (brand name Olumiant Tablet 2mg, etc.), which will take effect on July 1.

Previously, patients had to pay the full cost of the medication out-of-pocket. However, the scope of health insurance support has been broadened by incorporating medical textbooks, clinical research literature, and expert opinions.

As a result, the financial burden on severe patients who did not see results from existing treatments is expected to be significantly reduced.

To qualify for coverage, patients must meet both prior treatment and hair loss severity criteria.

First, patients must have been treated with existing therapies, such as steroids or cyclosporine, for at least three months without achieving a reduction of 30% or more in their Severity of Alopecia Tool (SALT) score, or they must have been unable to continue treatment due to side effects.

At the same time, health insurance will only be granted if the SALT score is 50 or higher, or if the patient has a clear interruption such as the loss of all eyebrows and eyelashes with a SALT score between 20 and 50.

The SALT score is a percentage value representing the area of hair loss relative to the total scalp area.

The effectiveness of the treatment will be evaluated to determine whether to continue coverage.

The first evaluation will be conducted at the 36th week of administration, and the SALT score must drop to 20 or below to continue receiving support.

Afterward, evaluations will be conducted every six months, and if the effectiveness is maintained, coverage can be granted for up to a maximum of two years.

Patients must submit objective supporting documentation, such as their history of medication administration and photographs of the affected area.

Long-term prescriptions are allowed for up to 30 days upon discharge or outpatient visits; however, if the disease is stabilized and there are no side effects after 24 weeks of initial treatment, up to 60 to 90 days of medication may be covered.

When administering the drug, contraindications and guidelines for the treatment of latent tuberculosis must be strictly followed.

Transitional provisions have also been established for patients who were already taking the medication at their own expense.

Patients who were already receiving the treatment before the notification takes effect must prove that they met the new coverage criteria at the time of their initial administration.

If the duration of intake has exceeded 36 weeks, the evaluation results from the 36th week must be submitted; if proof is difficult, an evaluation must be conducted in line with the effective date of the notification.

For existing patients, the coverage period is also limited to a maximum of two years from the effective date of the notification.
※ Please note: This article was translated by AI and may contain errors.