Kim Cheol-su (alias), 73, found he got pancreatic cancer, back in 2007. Heard about the low survival rate of pancreatic cancer, Kim, a janitor at an apartment, felt he was at the footsteps of death. In March, he underwent a surgery and had to have his entire pancreas taken out.

Kim’s prognosis was good, and he left the hospital before long. Soon, however, he ran into an unexpected opponent – “digestive medicine” Kim had to take after removing all of the pancreas. Patients like Kim ought to take “pancreatic enzyme” for life, in addition to insulin injections.

And he couldn’t help but surprised when he learned the digester’s price was far higher than insulin shots. Kim who has no pancreas has to take digestive drugs like “Norzyme Capsule 40000,” which has a high concentration of pancreatic enzyme. As the drug is excluded from coverage, however, Kim has to spend up to 80,000 won ($70) for drug administration alone. In contrast, Kim has only to pay about 20,000 for 90 days on average, as they get insurance benefits.

“I never knew digestive aids would be this expensive. Insulin shots are far cheaper than them. This poses heavy financial burdens on me as I have to take digestants for life,” Kim said. “There must be many patients like me who have to take digestives all their life. I hope the government provides insurance benefits to digestive medicines people like me have to take.”

Pancreatic cancer patients switching to cheaper – even no -- drugs

People like Kim -- who have eliminated their entire pancreas or suffer from chronic pancreatitis, in which pancreas cannot perform exocrine functions to produce digestive enzyme – have to take digestives for life. If they don’t, their bodies cannot absorb fats and nutrition, resulting in various symptoms, such as weight loss, metabolic bone disease, vitamin deficiency disease and malnutrition. The failure to absorb nutrition can lead to a life-threatening situation.

Treatments are quite simple. One has to take digestive medications with high levels of pancreatin every day. The government excluded all digestives from health insurance benefits in 2002, forcing patients to pay entire drug costs. Before the digestants, which were over-the-counter drugs, became uncovered medicine, patients with doctors’ description had only to pay 30 percent of drug costs.

Experts point out pancreatic patients’ financial burdens swelled because the government turned all digestives into non-payment items in a slump instead of dividing them by the disease their takers have. Among people who must take digestives because of pancreatic problems replace their medications with “cheaper drugs” that have low levels of pancreatin. Others even give up taking drugs.

Korea Pancreatobiliary Association (KPA) estimates the number of Koreans with chronic pancreatitis or pancreatic cancer at 26,615 as of 2016. Among them, 10,000 patients, nearly half of the total, have to take digestives because of exocrine pancreatic dysfunction, it says.

“Fats do various kinds of work in human bodies, including absorbing vitamins. If the fats are not absorbed, various problems can’t help but occur,” said Professor Park Byeong-kyu at the Department of Gastroenterology in National Health Insurance Service Ilsan Hospital, who also serves as the director of insurance at Korea Society of Gastrointestinal Endoscopy (KSGE).

People with exocrine pancreatic dysfunction have to take pancreatic enzyme supplements to absorb pats, Park said, adding that they should do so for life because the exocrine dysfunction is irreversible.

“Pancreatin with high concentration costs about 70,000 won to 80,000 won a month. Some patients find it burdensome when they are told to take it for a lifetime,” the professor said. “Some patients just opt to do without digestives, because pains do not usually increase even if they don’t take digestive drugs.”

Noting that the government is pushing to give insurance benefits to all healthcare services to increase coverage, Professor Park emphasized that digestives are essential therapies for patients with exocrine pancreatic dysfunction.

“That explains why the government should start by allowing patients with exocrine pancreatic dysfunction, such as those with chronic pancreatitis or pancreatic cancer, to take digestives with insurance benefits,” he added.

‘Digestives should get coverage by limiting it to pancreatic diseases’

Related academic societies have also persistently called for providing coverage for digestives taken by pancreatic disease patients. Korea Pancreatobiliary Association and Korea Society of Gastrointestinal Endoscopy have sent official documents to Health Insurance Review and Assessment Service (HIRA) and other agencies to ask for giving insurance benefits to patients who take digestives because of exocrine pancreatic dysfunction.

“The only way to improve exocrine pancreatic dysfunction caused by chronic pancreatitis, pancreatic cancer and pancreatectomy is to administer pancreatin continuously,” KPA said. “Currently, pancreatin gets no insurance benefits as it is categorized as non-prescription medicine. Some patients have no other choices but to take recently developed enteric-coated microsphere medicines, which cost about 72,000 won a month.”

Because of the diseases’ nature, patients have to take medicine for life at no small financial burden, the association noted. “It is necessary to expand insurance benefits to the pancreatic enzyme in the case of exocrine pancreatic dysfunction,” it said.

The Korean Association of Internal Medicine, in an opinion paper submitted to the National Assembly in October 2016, also pointed to the need to permit coverage for patients with exocrine pancreatic dysfunction as a result of chronic pancreatitis, pancreatic cancer and pancreatectomy, when they take pancreatin.

Despite criticisms from experts, the government has kept all digestive drugs under the uninsured category over the past decade. The reason: in the cases of medicines, pharmaceutical companies need to apply for insurance benefits, but domestic drugmakers prefer non-coverage to coverage in this particular case.

“In the case of medicines, pharmaceutical companies should apply for registration as insured drugs,” a HIRA official said. “Calls have been mounting for expanding coverage to digestives. Institutionally, however, we cannot make the decision itself unless there are applications for registry from the drugmakers.”

A university hospital professor explained why.

“If the drug is registered as covered medicine, it will sell more but its price, and revenue, falls. And, in the case of pancreatin, patients who need the drug can’t help but buy and take it, insured or not,” he said. “Pharmaceutical firms feel no need to take the trouble of applying for its coverage.”

All this shows why the government should move more actively, he added.