“Should we sell the house? Dad’s medication is just too expensive.”
This is the agonizing question keeping a mother in her 60s and a daughter in her 30s awake at night. Their story is not unique. When cancer is discovered late, the emotional blow is quickly followed by a staggering financial burden. While modern medicine has produced highly effective new drugs that can extend the lives of advanced cancer patients, the cost is often astronomical—exceeding 100 million won per year for medications not yet covered by National Health Insurance. Families are forced to choose between the life of a loved one and the roof over their heads.
The Critical Importance of Early Detection
The most effective way to avoid this financial and emotional tragedy is prevention and early detection. Cancer is notoriously deceptive; even at Stage 3, there may be no visible symptoms. If a patient waits until they feel physical pain to visit a hospital, the cancer has often already metastasized.
In the past, metastatic cancer was considered a death sentence. Today, new drugs offer a second chance at life, but their price tags make them inaccessible to most. Some patients even choose to decline treatment, refusing to let their families suffer financially for a few extra years of life. There is no greater tragedy than a life that could be saved if only the family had the money.
South Korea’s Lengthy Insurance Listing Process
For a drug costing 100 million won to become affordable, it must be listed under the National Health Insurance (NHI) system. However, the administrative process in South Korea is notoriously complex and slow.
Once the Ministry of Food and Drug Safety approves a drug, the pharmaceutical company must apply for NHI listing. This triggers a multi-stage review:
HIRA Adequacy Review: The Health Insurance Review & Assessment Service evaluates clinical usefulness and cost-effectiveness.
Price Negotiations: The National Health Insurance Service negotiates the drug price with the manufacturer.
Final Deliberation: The Ministry of Health and Welfare’s committee makes the ultimate decision.
As the risk of health insurance budget deficits rises, "money" has become the primary hurdle. Authorities worry that rapid coverage for every new drug will accelerate financial leakage, leaving patients and their families in a state of desperate anxiety.
The Reality: A Two-Year Wait for Life-Saving Meds
While the official processing period is meant to be around 210 days, the reality is far different. According to an analysis by the Korea Patient Advocacy Association covering 2021–2025, it took an average of 1 year and 10 months (659 days) for anticancer drugs to move from approval to insurance listing. For rare disease treatments, the wait was as long as 3 years and 10 months.
The breakdown of the delay for anticancer drugs includes:
6 months from approval to the initial insurance application.
5 months for the Cancer Disease Deliberation Committee.
6–7 months for the Drug Benefit Evaluation Committee.
Essentially, patients are often waiting over a year for administrative procedures after the application is filed—time that many Stage 4 patients simply do not have.
A Plea for "Rapid Listing, Post-Assessment"
Families are left with an impossible dilemma: Do they sell the house to pay 100 million won upfront and start treatment immediately, or wait for a listing that may come too late?
Advocates are calling for a "Rapid National Health Insurance Listing–Post-Assessment System." This policy would prioritize patient lives by allowing urgent treatments to begin first, shifting the evaluation of cost-effectiveness and budget impact to a post-treatment assessment.
Cancer can strike any family at any time. When a life is at risk, repetitive and sluggish administrative procedures should not be the reason the timing of treatment is missed. The story of a daughter apologizing to her father because they lack the funds for his medicine is a tragedy that could happen to any of us.
