Orthopedists express concern over benefit cuts for knee pain relief shots starting next July

The government will restrict the insurance benefits coverage of polynucleotide sodium (PN) injections from July next year. PN-based injections are used to relieve pain in patients with knee osteoarthritis.

According to the Korean Association of Orthopedic Surgeons, the reimbursement criteria for PN-based injections for intra-articular injection will change next July.

The out-of-pocket payment rate will increase from 80 percent to 90 percent, and the number of injections will be limited to a maximum of five within a six-month period. Previously, it was possible to re-dose after one cycle of up to five times within six months.

The association resisted, calling the new rule “medically unjustified.” In a position paper issued on Monday, the association said the intent to limit coverage of PN-based injections is to reduce the financial burden on health insurance.

“The health authorities should allow patients to get additional injections by maintaining the current selective benefit criteria or letting them pay all expenses on their own if needed,” it said.

The association criticized the Ministry of Health and Welfare for trying to reduce the burden on health insurance through benefit reductions rather than returning to unreimbursed treatment amid rocketing demand due to population aging, describing it as unconstitutional and a direct violation of physicians' right to practice medicine and patients' right to choose their treatment.

“If the policy is decided to restrict its use while the social need is increasing, it will cause a lot of confusion for doctors and patients on the frontline,” it said. ”If it is cost-effective from the perspective of health insurance financing, the reimbursement criteria can be limited. However, if the social need is considered, it can be maintained as an unreimbursed treatment or 100 percent out-of-pocket.”