Hidradenitis Suppurativa Biologic and Surgery Cost Calculator Korea

Plan South Korean hidradenitis suppurativa biologic and surgery costs while keeping V309 registration, drug reimbursement, covered, full-patient-payment, non-covered, and recovery costs separate.

Health cost scenario inputs

Enter Korea-related chronic care, eldercare, therapy, procedure, fertility, diagnostic, or medical tourism assumptions. Results are simplified planning estimates.

Treatment cost over period

₩1,537,260

Monitoring or support cost

₩0

Increase reserve

₩153,726

Planning window cost

₩1,690,986

12 months

This is a simplified South Korea planning view for hidradenitis suppurativa (HS). The dedicated Korean calculator separately computes IHS4, previews KDCA L73.22/V309 registration criteria, previews HIRA Notice No. 2025-189 starting-reimbursement criteria, counts Humira or Cosentyx doses, and itemizes a provider surgery quote. Current public anchors verified July 26, 2026 are Humira Pen 40 mg code 624900271 at KRW 284,677 from January 1, 2026, Cosentyx 150 mg code 653602641 at KRW 597,295 and Cosentyx Uno 300 mg code 653603531 at KRW 1,134,820 from December 1, 2025. A 52-week starting schedule is 54 Humira 40 mg pens or 16 Cosentyx 300 mg administrations when the ending week is excluded. Registered V309 care has a 10% covered copay under Notice No. 2026-101, not the 5% cancer rate, but non-covered and full-patient-payment items remain outside that 10%. Q3062 and Q3063 identify only anorectal-region HS excision/marsupialization and wide excision; they are not a national surgery price and do not automatically apply to axillary, groin, inframammary, or other sites. The shared English result is not the dedicated itemized calculation, medical advice, diagnosis, a prescription, a V309 registration decision, a HIRA coverage decision, a surgery-code decision, or an insurer estimate.

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South Korea · rules verified July 26, 2026

What this hidradenitis suppurativa cost calculator separates

Hidradenitis suppurativa, often shortened to HS, can involve recurring inflammatory nodules, abscesses, draining tunnels, scarring, pain, wound care, and time away from work.
A useful South Korean budget cannot treat all of those costs as one percentage of one average price.
This calculator therefore separates three questions that are easy to confuse.
The first question is whether the entered facts line up with the KDCA preview checklist for severe HS registration under disease code L73.22 and special mark V309.
The second question is whether the entered facts line up with HIRA’s starting-reimbursement criteria for adalimumab or secukinumab.
The third question is how much the household should prepare after the user enters a coverage status that the provider actually confirmed, current public drug-price anchors, an itemized surgery quote, and recovery-related costs.

A green checklist is not a diagnosis, V309 registration, drug approval, prescription, surgery recommendation, billing-code decision, or insurer decision.
Use the checklist to prepare questions and documents, then use the treating dermatologist, provider billing office, NHIS, and HIRA records as the controlling source.

IHS4 formula and severity boundaries

The International Hidradenitis Suppurativa Severity Score System, IHS4, weights three types of active lesion.
Each inflammatory nodule contributes one point, each abscess contributes two points, and each draining tunnel contributes four points.
The calculator applies the following formula to the counts entered from one clinical reference date.

Active-lesion score

IHS4 = nodules + 2 × abscesses + 4 × draining tunnels

0–3 points

Mild

The entered current-lesion score is in the mild IHS4 band.

4–10 points

Moderate

The entered current-lesion score is in the moderate IHS4 band.

11 or more points

Severe

Eleven is the severe IHS4 boundary used in the Korean checklists.

Why an IHS4 score of 11 is not enough by itself

Both Korean checklists pair the score threshold with Hurley stage II or III.
The severity branch is written as Hurley stage II or higher together with either an HS-PGA score of at least 4 or an IHS4 score of at least 11.
A person with IHS4 11 but Hurley stage I does not satisfy that combined severity branch on the entered facts.
A person with IHS4 10 may satisfy the score branch if a clinician has documented HS-PGA 4 or higher and Hurley stage II or III.
Hurley stage and HS-PGA should come from a clinical assessment rather than a self-assigned value.

V309 registration and biologic reimbursement are different checks

South Korea’s current special-case notice lists severe hidradenitis suppurativa as L73.22 with special mark V309.
A registered patient pays 10 percent of covered cost for care within the registered disease scope.
That is the rare-disease special-case rate, not the 5 percent cancer rate.
Registration does not turn non-covered or covered full-patient-payment items into 10 percent items.

Comparison of Korea V309 registration and biologic starting reimbursement checks
TopicKDCA V309 new-registration previewHIRA biologic starting-reimbursement preview
Age and diagnosis durationNo separate numeric entry in this previewAge 18 or older and at least one year since first diagnosis
DistributionTypical location and typical lesion findingsLesions in at least two distinct sites
Lesion countRecurrence and typical findings are checkedAbscesses plus inflammatory nodules total at least three
Prior coursePainful or suppurative lesions recur at least twice within one yearAt least three months of antibiotics with inadequate effect or discontinuation for adverse effects
SeverityHurley II or III and HS-PGA 4+ or IHS4 11+The same combined severity branch
Professional confirmationClinical confirmation by a dermatologistPrescription and reimbursement are confirmed by the treating institution

KDCA new-registration preview

  1. Painful or suppurative lesions have recurred at least twice within one year.
  2. Typical sites and findings are present, including relevant axillary, vulvofemoral, perineal, buttock, or female inframammary sites and typical nodules, sinus tracts, abscesses, or scars.
  3. Hurley stage is II or III and either HS-PGA is at least 4 or IHS4 is at least 11.
  4. A dermatologist has clinically confirmed the condition.

HIRA starting-reimbursement preview

  1. The patient is age 18 or older and at least one year has passed since the first HS diagnosis.
  2. Lesions are present in at least two distinct sites.
  3. The combined number of abscesses and inflammatory nodules is at least three.
  4. Antibiotics were used for at least three months and had inadequate effect, or treatment stopped because of adverse effects or a similar documented reason.
  5. Hurley stage is II or III and either HS-PGA is at least 4 or IHS4 is at least 11.

The Korean calculator never switches the cost to covered status merely because the preview checklist is green.
The user must select covered or drug-cost full patient payment from a provider-confirmed status, and must separately confirm whether V309 registration is active.

Response checks after biologic treatment starts

Starting reimbursement is not an unlimited promise that every later dose remains covered.
HIRA’s current adalimumab criteria assess response after 12 weeks.
The current secukinumab criteria assess response after 16 weeks.
At the relevant first assessment, the number of abscesses or draining fistulas must not have increased and the combined abscess plus inflammatory-nodule count must have fallen by at least 50 percent.
Continued treatment is then reviewed every 24 weeks against maintenance of the initial response.
Secukinumab’s covered HS maintenance schedule is every four weeks and the current reimbursement period is limited to 104 weeks.

Adalimumab

First reimbursement response check at week 12.
Later response checks occur every 24 weeks when the first response is maintained.

Secukinumab

First reimbursement response check at week 16.
Later checks occur every 24 weeks, with covered maintenance every four weeks and a maximum covered HS period of 104 weeks.

If reimbursement after the first assessment is uncertain, budget the first 12 or 16 weeks first rather than assuming one coverage status for a full year.
Recalculate the later period after the clinician documents the response and the provider confirms the next prescription and claim status.
The calculator does not predict HiSCR or an individual treatment outcome.

Current public price anchors and dose counts

The Korean calculator uses current HIRA benefit-history price anchors and Korean authorized HS schedules.
A public ceiling price is not the same as the final amount on a patient receipt.
Actual transactions, risk-sharing arrangements, dispensing, consultation, testing, and claim details can produce a different bill.

Current Korea HS biologic public price anchors and 52-week counts
Product and HIRA codeUnit ceiling priceStarting 52 weeksMaintenance 52 weeks
Humira Pen 40 mg
624900271 · effective January 1, 2026		KRW 284,67754 pens · KRW 15,372,55852 pens · KRW 14,803,204
Cosentyx Uno 300 mg
653603531 · effective December 1, 2025		KRW 1,134,82016 doses · KRW 18,157,12013 doses · KRW 14,752,660
Cosentyx 150 mg, two pens per 300 mg dose
653602641 · effective December 1, 2025		KRW 597,295 per pen32 pens · KRW 19,113,44026 pens · KRW 15,529,670

How the 52-week starting courses are counted

The calculation uses a half-open interval from week zero up to, but not including, week 52.
For adalimumab, the authorized adult HS schedule is 160 mg at week zero, 80 mg at week two, then 40 mg every week from week four, or an authorized 80 mg every-two-week alternative.
The default public-price preset uses 40 mg pens, so the first two loading doses use four and two pens and weeks four through 51 add 48 pens.
That produces 54 billable 40 mg pens in the starting 52-week window and 52 pens in a maintenance-only 52-week window.
For secukinumab, the authorized HS schedule is 300 mg at weeks zero, one, two, three, and four, followed by 300 mg every four weeks.
The starting window therefore contains five loading administrations and eleven later administrations at weeks eight through 48, for 16 total.
A maintenance-only 52-week window contains 13 administrations.

Use the Korean calculator’s custom monthly amount for an adalimumab biosimilar, a different package, the authorized 80 mg every-two-week regimen, secukinumab every two weeks, or any provider plan that does not match the preset.
Do not force a different prescription into the preset dose counter.

Why surgery uses a provider quote, not a national average

HS procedures can range from incision and drainage or local treatment to deroofing, local excision, wide excision, grafting, or flap reconstruction.
Cost changes with the body site, surface area, number of stages, anesthesia, admission, pathology, wound method, reconstruction, and follow-up.
A single nationwide average would conceal those differences and could create false confidence.
The calculator therefore starts surgery amounts at zero and asks for an itemized provider quote.

Covered total amount

Enter the covered service total before the patient copay, including the insurer share. Do not enter an already reduced patient payment in this field.

Covered full-patient-payment amount

Enter only an amount identified as full patient payment on the quote or itemized statement. The calculator leaves it at 100 percent.

Non-covered amount

Enter provider-priced non-covered items separately. V309 and the annual covered-cost ceiling do not reduce this field.

Wound care and supplies outside the quote

Add only confirmed dressing, antiseptic, pressure, or wound-supply amounts that the main quote does not already include.

The Q3062 and Q3063 boundary

HIRA’s public classification identifies Q3062 as excision or marsupialization and Q3063 as wide excision for hidradenitis suppurativa in the anal and rectal region.
Those codes do not automatically apply to an axillary, groin, inframammary, buttock, or other operation.
They also do not represent the complete bill for anesthesia, pathology, admission, materials, grafting, flap reconstruction, or wound care.
The provider’s planned procedure, body site, claim classification, and itemized quote control the budget.

How the Korean cost model works

  1. The drug gross amount equals the number of scheduled billable units within the selected one-to-twelve-month window multiplied by the public unit price.
    A custom plan equals the provider-confirmed monthly drug amount multiplied by the selected months.
  2. A provider-confirmed covered drug or covered surgery amount uses the V309 rate of 10 percent only when the user confirms active V309 registration.
    Otherwise the user-selected ordinary planning rate is used, such as 20 percent inpatient or 30–60 percent outpatient depending on the selected care setting.
  3. Drug-cost full patient payment, surgery full patient payment, non-covered surgery, and separately entered wound-care cost remain at 100 percent.
  4. If the optional annual covered-cost ceiling is used, the current covered copay is limited to the remaining room after the user enters an NHIS-confirmed annual ceiling and other covered copays from the same calendar year.
  5. Confirmed medical reimbursement is capped at direct medical cost after the optional ceiling.
    The model does not guess a private-insurance reimbursement ratio.
  6. Travel, lodging, and patient or companion lost income are added as non-medical household cost.
  7. The contingency reserve equals the net household cost multiplied by the entered reserve percentage.
    The final planning amount equals net medical cost, indirect cost, and the contingency reserve.

Step-by-step use

  1. Enter inflammatory nodules, abscesses, and draining tunnels from the same current clinical reference date.
    Enter clinician-documented Hurley stage and HS-PGA rather than a self-assigned value.
  2. Enter age, months since first diagnosis, number of involved sites, antibiotic duration and response, recurrence, typical findings, and dermatologist confirmation.
  3. Read the V309 and biologic checklists separately.
    Treat an unmet row as a question for the dermatologist or billing team, not as a final rejection.
  4. Select the public Humira or Cosentyx preset and starting or maintenance phase, or enter a provider-confirmed monthly amount for a different plan.
  5. Select covered or drug-cost full patient payment from the provider’s actual status.
    Confirm V309 registration separately rather than allowing the checklist to switch it automatically.
  6. Split the surgery quote into covered total, covered full patient payment, non-covered, and extra wound-care fields.
    Do not multiply a whole-plan quote by lesion count or area.
  7. Add travel, lodging, and lost income, then subtract only a medical payment that has already been confirmed.
  8. Use the optional ceiling only with an NHIS-confirmed annual amount and same-calendar-year covered-copay total.
    Split a plan that crosses December and January into separate yearly scenarios.

Worked planning example

The built-in Korean example is hypothetical and is not a national average or a predicted patient bill.
It uses age 34, 24 months since diagnosis, three involved sites, three inflammatory nodules, two abscesses, and one draining tunnel.
IHS4 is therefore 3 + 2 × 2 + 4 × 1, which equals 11.
It also assumes Hurley stage II, HS-PGA 4, four months of antibiotics with inadequate response, qualifying recurrence and typical findings, dermatologist confirmation, active V309 registration, and provider- confirmed covered Humira.
The surgery quote is entered as KRW 5,000,000 covered total, KRW 500,000 covered full patient payment, KRW 1,000,000 non-covered, and KRW 200,000 additional wound care.
Travel is KRW 100,000, lost income is KRW 1,000,000, confirmed medical reimbursement is KRW 300,000, and the reserve is 10 percent.
The optional annual ceiling is off.

Hypothetical Korea HS biologic and surgery planning example
Planning lineAmount
Humira starting 52-week public grossKRW 15,372,558
Drug self-pay at confirmed V309 10%KRW 1,537,256
Surgery covered total at confirmed V309 10%KRW 500,000
Surgery full payment, non-covered, and wound careKRW 1,700,000
Direct medical cost before confirmed reimbursementKRW 3,737,256
Direct medical cost after KRW 300,000 paymentKRW 3,437,256
Household cost after travel and lost incomeKRW 4,537,256
Ten-percent contingency reserveKRW 453,726
Total planning amountKRW 4,990,982

The result is KRW 4,990,982, or an average KRW 415,915 across twelve months.
Those values demonstrate the formula only.
Replace every quote, coverage choice, registration choice, and confirmed payment with the individual Korean records.

Optional annual out-of-pocket ceiling

South Korea’s annual out-of-pocket ceiling can refund eligible covered patient cost above an individual annual limit.
The applicable amount can change by year and individual conditions, so this calculator does not hardcode an income-tier table.
It asks the user to enter an NHIS-confirmed annual ceiling and eligible covered copays already paid in the same calendar year.
The current covered drug and surgery copay is then limited to the remaining room.

Included in this optional estimate

  • The selected covered drug copay.
  • The copay calculated from the entered covered surgery total.
  • Other eligible covered copays entered for the same year.

Excluded from this optional estimate

  • Drug or surgery full patient payment and non-covered cost.
  • Wound-care cost whose covered status is not separately known.
  • Travel, lodging, and patient or companion lost income.

The display is an estimate of the current scenario’s covered-cost room, not a claim or refund decision.
A treatment window crossing a calendar-year boundary must be split, because a single annual ceiling cannot be carried across both years.

Questions to take to the provider

Dermatology record

What are the documented diagnosis date, Hurley stage, HS-PGA, IHS4 component counts, involved sites, antibiotic duration, and response history?

Registration and drug claim

Is V309 active, is this prescription covered for HS, what product and package will be dispensed, and when is the next response assessment?

Surgery quote

Does the quote include anesthesia, pathology, admission, reconstruction, graft or flap, dressing, materials, and scheduled follow-up?

Billing classification

Which amount is covered total, covered full patient payment, non-covered, and patient-paid outside the quote, and is the service within the V309 disease scope?

Frequently asked questions

Does IHS4 11 automatically create V309 registration?

No. The KDCA preview also checks recurrence, typical sites and findings, Hurley stage II or III, and dermatologist confirmation. Registration requires the actual Korean process and records.

Does active V309 registration automatically cover Humira or Cosentyx?

No. The drug has a separate HIRA starting-reimbursement pathway that checks age, diagnosis duration, site count, lesion count, antibiotics, response or intolerance, and severity. The treating institution must confirm the claim status.

Is the V309 covered copay 5 percent?

No. The current notice identifies a 10 percent rare-disease covered copay for this registration. Five percent is associated with the cancer special-case rate and must not be substituted here.

Does every adalimumab biosimilar cost the same as Humira?

No. Products and packages can have different listed prices. The preset is the Humira Pen 40 mg public price anchor, so a different product should use the provider-confirmed monthly amount.

Why does choosing Q3062 or Q3063 not insert a surgery price?

Those codes classify specified anorectal-region HS procedures and are not an all-inclusive national bill. Body site, procedure scope, anesthesia, admission, pathology, materials, and reconstruction still require the provider quote.

Why is private indemnity insurance not estimated automatically?

Coverage generation, product terms, deductibles, inpatient or outpatient limits, non-covered riders, exclusions, and documents vary. The calculator subtracts only an amount whose payment is already confirmed.

Does a zero field mean the service is free?

No. Zero may simply mean that no receipt or quote has been entered. Confirm every missing amount rather than reading zero as a benefit decision.

Can the calculator choose between a biologic and surgery?

No. It compares budget components only. Treatment choice and sequencing depend on the dermatologist and surgical team, disease pattern, prior response, risks, preferences, and clinical judgment.

Safety and interpretation notes

  • Count lesions from one reference date and do not combine old photos, drained lesions, and a current examination into one score.
  • Biologic treatment can require infection and tuberculosis assessment and other clinical safety review.
    A lower calculated cost is never a reason to start, stop, or switch a prescription without the treating clinician.
  • Rapidly worsening pain or swelling, fever, spreading redness, marked odor or drainage, or systemic deterioration needs medical assessment rather than more budgeting.
  • Do not multiply an all-lesion or whole-operation quote by lesion count or area.
    If the team plans staged surgery, obtain and enter each stage as a separate scenario.
  • Put the V309 registration date, first biologic dose, week-12 or week-16 response review, later 24-week reviews, operation date, and expected recovery window on one calendar.
    That makes both drug timing and income interruption easier to plan.

Official Korean sources used

Turn the checklist into provider questions and an itemized budget

Confirm missing clinical rows with the dermatologist, confirm V309 and drug coverage with the institution and NHIS records, and ask the billing office to separate covered total, full patient payment, non-covered, and wound-care amounts.
Then replace the public-price example and hypothetical surgery fields with the actual Korean prescription and quote.

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