Prescription drugs to treat hay fever containing a similar content as their nonprescription equivalents should be excluded from public medical insurance coverage, the National Federation of Health Insurance Societies said in a proposal on Friday.
Kenporen, as the federation is commonly known, drafted the proposal as a measure to enhance the financial health of the public medical insurance system, which is struggling with negative effects of a graying population.
The federation of health insurance unions for corporate employees suggests that the move would help reduce the country’s medical costs by as much as around ¥59.7 billion a year.
However, hay fever patients who pay just 10% to 30% of the costs of such drugs owing to the coverage, will have to dig into their own pockets to pay the full cost.
The release of cedar pollen, which affects much of the country’s population between February and May every year, triggers an allergic reaction in about 1 in 4 people of around 126 million.
Cedar pollen allergies were not frequent in Japan until the mid-1960s, when the early cases were reported near a cedar forest in Nikko, Tochigi Prefecture.
In the 1950s and 1960s, it was a national policy to plant forests of Japanese cedar and cypress trees, as they grew quickly and produced hardwood for construction.
But trade liberalization saw cheaper hardwoods from Southeast Asia flood the market and the cedar, leaving the cedar and cypress forests to grow unattended, and the result was large emissions of pollen each spring.
The proposal to remove public medical coverage of hay fever drugs was presented at a convention of the Central Social Insurance Medical Council, which works closely with the health minister, ahead of medical service fee revisions for fiscal 2020.
Kenporen examined medical consultations received by individuals who’re insured by its member unions, part of the nation’s universal medical insurance system, between October 2016 and September 2018.
From the analysis, the federation found an estimate that the elimination of one hay drug alone from the insurance coverage would cut annual drug costs paid under the insurance system by ¥3.7 billion. The proposal suggested the exclusion of any hay fever drugs should begin with a limited scope.
Premiums paid by insured employees are expected to increase further, as the financial health of several unions is expected to deteriorate because of the introduction of very expensive medicines costing millions of yen.
Corporate health unions also need to increase contributions to fund health care for the aging population.
Japan’s health insurance federation estimates the overall medical costs for prescription drugs that can be replaced by nonprescription counterparts at ¥212.6 billion.
Previously, Kenporen also proposed excluding from coverage covering packing sheets and moisturizers that are prescribed by medical firms but can be replaced by nonprescription ones.
“Certain exclusions are necessary” to maintain the public medical insurance system, a Kenporen spokeperson said.
Moreover, the new proposal called for broader use of affordable generic drugs for treating lifestyle illnesses, estimating that prices of medicine could drop by ¥314.1 billion a year in doing so.