[MHLW] Expansion of Coverage for Medical Expense Subsidies for Specific Pediatric Chronic Diseases

On  February 15, 2022, the Children's Affairs Division of the Social Security Council reported on "the scheme of subsidizing medical expenses for specific pediatric chronic disease for those who do not have symptoms specified in the relevant conditions of the disease." This report was a response to a consultation from the Minister of Health, Labour and Welfare (referred to as "Minister") to the President of the Social Security Council dated January 28, 2022.

With the recent progress of medical science, drugs that are expected to have therapeutic effects when administered before symptoms manifest are now covered by insurance. However, it has been pointed out that some pediatric chronic diseases require "the presence of some symptoms" as the "relevant conditions of the disease" in order to qualify for subsidized medical care, and it is not always clear whether the administration of such drugs is eligible for subsidized medical care. Therefore, it was proposed that in certain cases, even if symptoms are not apparent, necessary treatment would be covered by medical expense subsidies.

Concerning the "pediatric chronic diseases specified by the Minister based on the provisions of Article 6-2, paragraph 1 of the Child Welfare Act and the degree of relevant conditions of the disease specified by the Minister for each such disease based on the provisions of paragraph 2 of the same article (Notification No. 475 of the MHLW, 2014)", the report states explicitly that the following text is to be added to the remarks under "the degree of relevant conditions of the disease" for each such chronic disease group:

When the treatment (limited to treatment provided as an insured treatment) is provided to a person who does not present symptoms specified as the relevant conditions of the disease, and at the same time, the treatment mentioned above is covered by insurance because the person is anticipated to manifest the relevant symptoms: in that case, it is considered to meet the relevant conditions of the disease.

For more information, please visit the website below (Japanese only):
https://www.mhlw.go.jp/stf/shingi/shingi-hosho_126709.html

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