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Govt panel OK’s insurance coverage of new leukemic therapy

Courtesy of Novartis Pharma K.K.

The newly-approved Kymriah product

The Yomiuri Shimbun A health ministry advisory panel on Wednesday approved coverage of Kymriah therapy, a new immunotherapy for leukemia and other diseases produced and sold by pharmaceutical giant Novartis Pharma K.K., under the public health insurance system.

The Central Social Insurance Medical Council set the official price for the therapy at ¥33.49 million effective next Wednesday.

According to the Health, Labor and Welfare Ministry, Kymriah commands the highest price of any drug or treatment covered by the health insurance system.

Nevertheless, the cost is still lower than the roughly ¥40 million to ¥50 million charged in the United States and European countries, which have already introduced the therapy for leukemia patients.

Through Kymriah therapy, also known as “chimeric antigen receptor (CAR) T-cell therapy,” immune system cells are extracted from a patient’s blood and genetically modified to enhance their ability to fight cancer cells, before being reinserted through intravenous drip infusion.

The insurance system will cover treatment for patients 25 years or younger suffering a recurrence of B-cell acute lymphoblastic leukemia, as well as patients suffering a recurrence of diffuse large B-cell lymphoma. Patients fighting the two blood cancers who are showing resistance to treatment will also be eligible for Kymriah therapy.

According to Novartis, up to 216 patients will receive the treatment annually, with sales for the therapy expected to reach ¥7.2 billion.

Only one dose of the treatment is administered, but is expensive as the therapy needs to be customized for each individual patient. The process for manipulating genes and cultivating immune system cells is also costly.

In the United States, Kymriah costs about ¥50 million, and only those who respond positively after a month of treatment are required to pay the fee.

In Japan, patients can cover their expenses through public health insurance once a particular treatment is approved for coverage under the system, with an upper limit placed on the amount they must pay.

The vast majority of expenses for Kymriah therapy will be covered by insurance. A 40-year-old company employee with an annual income of ¥5 million, for example, will only to be paying about ¥400,000.Speech

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