Japan's National Diet passed an amendment to the Health Insurance Law adding a 25% co-payment for approximately 1,100 over-the-counter-like drugs [1].

This legislative shift changes how patients pay for common medications that are available both by prescription and as over-the-counter purchases. The move aims to reduce the financial burden on the national insurance system while redirecting funds toward new social welfare initiatives.

The new rule targets drugs that are considered similar to those sold without a prescription, known as OTC-like drugs. This list includes roughly 1,100 items [1] encompassing 77 different active ingredients [1]. Common medications such as Loxonin and Allegra are among the affected products [1].

Under the amended law, patients will be required to pay an additional 25% of the drug cost [1]. This surcharge is designed to encourage patients to purchase these specific medications over the counter rather than through the insurance-subsidized prescription system.

Lawmakers said the revenue generated from these increased co-payments will help fund a newly created free-birth-cost system. The amendment also includes revisions to high-cost medical expense caps, which were adjusted to consider the financial impact on low- and middle-income households [1].

The changes are not immediate. The government plans to implement the new co-payment rules starting in March 2025 [1].

The legislation moved through both the House of Councillors and the House of Representatives health-labor committees before receiving final approval in May 2024 [1].

“Patients will be required to pay an additional 25% of the drug cost.”

This policy represents a strategic shift in Japan's healthcare economics by narrowing the price gap between prescription and over-the-counter medications. By increasing the cost of 'OTC-like' drugs for insured patients, the government is attempting to lower the volume of insurance claims for non-essential prescriptions. This allows the state to reallocate resources toward critical maternal health services, such as the free-birth-cost system, amid an aging population and rising healthcare expenditures.