What is atopic dermatitis biologic/systemic therapy (Dupixent)?
This calculator estimates the annual drug cost and the real out-of-pocket burden of systemic treatments for moderate-to-severe atopic dermatitis, centered on Dupixent (dupilumab).
You pick a drug — Dupixent (dupilumab), Adtralza (tralokinumab), Ebglyss (lebrikizumab), Cibinqo (abrocitinib), Rinvoq (upadacitinib), Olumiant (baricitinib), or conventional cyclosporine — and an age/weight group, and it applies coverage, the copay special case, the annual out-of-pocket ceiling, private indemnity insurance, and the medical-expense tax credit, step by step.
Biologics cost several million to over 20 million KRW a year, but for the same drug the real burden varies enormously with (1) whether it meets the reimbursement criteria, (2) special-case registration, and (3) the annual out-of-pocket ceiling.
Severe atopic dermatitis is a registered special-case condition — ICD code L20.85, special mark V308, a chronic refractory disease — so the covered copay is 10% (not the 5% used for cancer).
Korea-based estimate. This calculator is built on Korean National Health Insurance rules for 2026 (severe atopic dermatitis special-case registration L20.85/V308, the annual out-of-pocket ceiling, private indemnity insurance, and the medical-expense tax credit). Drug prices are benefit-ceiling figures that change with formulation, weight-based dosing, and price negotiation; only Dupixent’s prices are directly sourced, while the others are public estimates. It is an educational estimate, not medical advice, and does not replace diagnosis, treatment decisions, a hospital quote, or an insurer/benefit decision.
Systemic drugs for atopic dermatitis
When moderate-to-severe atopic dermatitis is not controlled by topical therapy (steroids, calcineurin inhibitors) and phototherapy, treatment escalates to systemic therapy.
Systemic options fall into three groups: injectable biologics, oral JAK inhibitors, and conventional immunosuppressants.
Biologics (subcutaneous self-injection)
- • Dupixent (dupilumab): blocks IL-4/IL-13 signaling; adults 300 mg every 2 weeks; reimbursed for all ages 6 months and up
- • Adtralza (tralokinumab): selective IL-13 blockade; reimbursed for adults and adolescents (12–17); can switch to every 4 weeks after week 16
- • Ebglyss (lebrikizumab): IL-13 inhibitor; reimbursed from 2025 for adults and adolescents (≥40 kg); every-4-week maintenance
Oral JAK inhibitors (pills)
- • Cibinqo (abrocitinib): JAK1 inhibitor, once daily, fast itch relief; reimbursed from age 12
- • Rinvoq (upadacitinib): JAK1 inhibitor, once daily 15 mg maintenance or 30 mg escalation; reimbursed from age 12
- • Olumiant (baricitinib): JAK1/2 inhibitor; reimbursement extended to adults and children aged 2–17
Conventional systemic immunosuppressant
- • Cyclosporine: the traditional systemic option; cheap but limited for long-term use by nephrotoxicity and hypertension.
- • To qualify for biologic/JAK reimbursement, adults usually must first have tried a systemic immunosuppressant such as cyclosporine and shown inadequate response or side effects.
Oral JAK inhibitors carry risks (herpes zoster, venous thrombosis, infection) that require regular monitoring and vaccination counseling.
Drug choice weighs age, comorbidities, convenience, and cost together, and should be decided with your physician.
When is it covered? (reimbursement criteria by age)
Because biologics are expensive, they are not covered from the outset — only severe patients who did not respond adequately to prior therapy qualify.
If you are treated without meeting the criteria, you pay 100% of the drug cost as non-covered.
Criteria by age (summary)
- • Adults and adolescents (12–17): EASI ≥ 23, disease for 3+ years, and inadequate response or side effects after 3+ months of a systemic immunosuppressant (cyclosporine or MTX) following topical therapy
- • Children (6–11): EASI ≥ 21, disease for 1+ year, uncontrolled after 4+ weeks of topical therapy (systemic-therapy failure not required)
- • Infants (6 months–5 years): EASI ≥ 21, no minimum disease duration, with a history of topical therapy and inadequate control
Dupixent coverage widened from adults (2021) to adolescents and children (April 2023) and infants (August 2024); by 2026 all ages 6 months and up are covered with the special case.
Even after starting on coverage, response is reassessed periodically. The exact rules follow the Ministry of Health and Welfare notice on detailed reimbursement standards, and require a physician’s judgment.
The special case is 10%, not 5% (V308)
Many people confuse this with the cancer special case (5% copay), but the special case for severe atopic dermatitis is a chronic refractory disease, so the copay is 10%.
Even so, insurance covers 90% of the covered drug cost, which cuts the burden sharply.
Chronic refractory disease special case — key points
- • Severe atopic dermatitis (L20.85): special mark V308, chronic refractory disease special case, copay 10%
- • Other atopic dermatitis (L20.88): managed under special mark V252; unspecified (L20.9) is not a special-case condition
- • Registration period: valid for 5 years from confirmed diagnosis, with re-registration if the disease persists
- • Difference from cancer: cancer/severe-burn special cases are 5%, but atopic dermatitis, as a chronic refractory disease, is 10%
The basis is the Ministry of Health and Welfare notice “Standards for Special Cases of Copayment” (Notice No. 2026-101, effective 2026-05-01), Article 5 and Annex 4-2, and Annex 2 of the Enforcement Decree of the National Health Insurance Act.
The special case applies only to covered items — the 10% does not apply to non-covered drug cost.
The 10%→5% cut in H2 2026 is “planned”
The government announced it will cut the special-case copay for rare and chronic refractory diseases from 10% to 5%, planned for the second half of 2026.
However, the current notice (No. 2026-101) still specifies 10%, so treat this calculator’s 5% option as a planned simulation value and confirm the latest standard when you are actually billed.
Age and weight change the drug cost
Dupixent’s dosing interval differs between adults and lower-weight children/infants, so the annual drug cost varies widely.
Pick the right age/weight group to reflect the real drug cost.
- • Adults (18+): 600 mg loading, then 300 mg every 2 weeks (~26 doses/year) → about KRW 17.5 million/year at the benefit-ceiling price
- • Adolescents (12–17): 300 mg every 2 weeks at ≥60 kg, 200 mg every 2 weeks at 30–60 kg (lower cost)
- • Children (6–11): typically 300 mg every 4 weeks (~13 doses/year) → about half the adult cost
- • Infants (6 months–5 years): 200–300 mg every 4 weeks by weight
Dupixent’s 2026 benefit-ceiling price is about KRW 675,753 for 300 mg and about KRW 571,862 for 200 mg.
Oral JAK inhibitors (Cibinqo, Rinvoq, Olumiant) are taken once daily, roughly KRW 6.5–11.5 million a year depending on dose escalation.
Out-of-pocket ceiling and medical-expense tax credit
Biologics are often taken near-continuously for years, so the annual out-of-pocket ceiling and the medical-expense tax credit greatly lower the real burden.
Both are based on the covered copay and the burden remaining after private-insurance reimbursement.
Two programs — key points
- • Annual out-of-pocket ceiling: if annual covered copay exceeds the income-tier cap (about KRW 900,000–8,430,000 in 2026), the excess is refunded, and it applies again every year during long-term treatment
- • Medical-expense tax credit: 15% of medical spending above 3% of gross salary, excluding private-insurance reimbursement
- • Serious-illness limit: registered special-case patients have no KRW 7,000,000 cap on the medical-expense tax credit (Income Tax Act Article 59-4(2))
- • Without registration, the ordinary KRW 7,000,000 annual cap applies
Non-covered drug cost is not eligible for the ceiling refund, and any amount already refunded by the ceiling must be excluded from the tax credit to avoid double-counting.
How to use this calculator
Step 1: Age and drug
Pick the age group (adult, adolescent, child, infant), then the drug covered for that age, coverage status, and treatment period.
Changing the age recomputes the dosing interval and annual drug cost automatically.
Step 2: Copay conditions
Set special-case registration and copay rate (10% current / 5% planned for H2), care setting, income tier, and the out-of-pocket ceiling.
Choosing non-covered automatically removes the special case and the ceiling.
Step 3: Insurance and tax credit
Enter your private indemnity insurance generation and gross annual salary to reflect reimbursement and the medical-expense tax credit.
Step 4: Review results
See annual copay, the 10% vs 5% comparison, special case vs unregistered, covered vs non-covered, the ceiling refund, private-insurance reimbursement, the tax credit, and the final real burden at a glance.
Frequently asked questions (FAQ)
Q. Is the severe-atopic-dermatitis special-case copay 5% like cancer?
A. No. Cancer is a serious-illness special case at 5%, but severe atopic dermatitis (L20.85/V308) is a chronic refractory disease special case, so the copay is 10%.
Insurance still covers 90% of the covered drug cost, and you can get an additional refund through the out-of-pocket ceiling.
Q. Is Dupixent covered for children?
A. Yes. As of 2026, Dupixent is covered with the special case for all ages 6 months and up.
Children and infants are often dosed every 4 weeks by weight, so their annual drug cost is lower than adults’.
Q. How much is Dupixent if it isn’t covered?
A. If you are treated fully non-covered because you don’t meet the criteria, you pay 100% of the drug cost.
For adult every-2-week dosing that is about KRW 18 million/year at the benefit-ceiling price, up to about KRW 24 million at market non-covered prices, with no special case or ceiling benefit.
Q. Are the oral drugs (Cibinqo, Rinvoq) cheaper than injections?
A. Oral JAK inhibitors run roughly KRW 6.5–11.5 million a year, generally lower than adult Dupixent (about KRW 17.5 million).
But cost rises with dose escalation and they require monitoring for herpes zoster and thrombosis, so decide with your physician on safety and convenience, not just price.
Q. Can private insurance reimburse the injection cost?
A. Therapeutic biologic injections and drug costs are eligible for private indemnity insurance.
It reimburses the covered copay and non-covered drug cost at your generation’s coinsurance rate, subject to per-visit and annual limits — check your policy.
Important notes
- Reference estimate: prices vary with actual transaction price, weight, dose, and risk-sharing agreements; this calculator uses 2026 public drug prices. Prices for IL-13 and JAK drugs other than Dupixent are estimates.
- Coverage is individual: whether the criteria (EASI, systemic-therapy failure, etc.) are met depends on the patient, so confirm with your physician and HIRA.
- 5% is planned: the 10%→5% cut is planned for H2 2026, before the confirming notice; the current rate is 10%.
- Rules change: special-case criteria, drug prices, and the out-of-pocket ceiling can change yearly — check the latest notice.
Estimate your atopic dermatitis biologic cost now
Enter age, drug, special case, and income tier to see the annual real burden of Dupixent and other systemic drugs.
Compare the special-case 10% vs 5% (planned) and the out-of-pocket ceiling refund in one place.