What is the IPF antifibrotic cost calculator?
This calculator estimates the annual drug cost and the real out-of-pocket burden of antifibrotic therapy for idiopathic pulmonary fibrosis (IPF) — pirfenidone and nintedanib.
You pick Pirespa (pirfenidone) or Ofev (nintedanib), and it applies coverage, the rare-disease copay special case, the annual out-of-pocket ceiling, private indemnity insurance, and the medical-expense tax credit, step by step.
Antifibrotics cost several million to about 20 million KRW a year, but for the same IPF patient the real burden varies enormously with which drug is used and whether the special case is registered.
Critically, in Korea only pirfenidone is reimbursed for IPF; nintedanib (Ofev) is fully non-covered for IPF.
Korea-based estimate. This calculator is built on Korean National Health Insurance rules for 2026 (IPF rare-disease special-case registration J84.11 / V236, the annual out-of-pocket ceiling, private indemnity insurance, and the medical-expense tax credit). Drug prices are benefit-ceiling figures that change with actual transaction price, generics, and risk-sharing agreements. It is an educational estimate, not medical advice, and does not replace diagnosis, treatment decisions, a hospital quote, or an insurer/benefit decision.
IPF and antifibrotic therapy
Idiopathic pulmonary fibrosis is a chronic, progressive interstitial lung disease in which the lungs gradually scar (fibrosis) for unknown reasons, steadily reducing lung capacity.
It usually begins after age 50 and has a poor prognosis — a median survival of about 3–5 years — and is classified as a rare disease.
Antifibrotics slow the progression of lung fibrosis, aiming to roughly halve the rate of decline in FVC (forced vital capacity).
They do not cure or reverse damaged lung, but they slow the disease and reduce complications such as lung cancer and acute exacerbation.
Pirfenidone (Pirespa)
- • Form: pirfenidone 200 mg tablet (Ildong Pirespa, plus multiple generics)
- • Dosing: start at 600 mg/day, titrate up every 2 weeks, maintenance 1,800 mg/day (600 mg three times daily = 9 tablets/day)
- • IPF coverage: reimbursed since 2015 via a risk-sharing agreement (RSA); eligible for the rare-disease special case at 10%
- • Side effects: photosensitivity (sun exposure), GI upset (nausea/diarrhea), rash, appetite loss, elevated liver enzymes
Nintedanib (Ofev)
- • Form: nintedanib 100 mg / 150 mg soft capsule (Boehringer Ingelheim Ofev)
- • Dosing: 150 mg twice daily (300 mg/day = 2 capsules/day), reduced to 100 mg twice daily if not tolerated
- • IPF coverage: fully non-covered for IPF (reimbursed only for SSc-ILD and progressive pulmonary fibrosis)
- • Side effects: diarrhea (over 60%), elevated liver enzymes, nausea, weight loss; regular liver function tests required
There is no head-to-head trial between the two drugs, so neither is clearly superior, and combination therapy is not standard.
The choice weighs side-effect profiles (pirfenidone = photosensitivity/GI; nintedanib = diarrhea/liver enzymes), comorbidities, and convenience together with your physician.
Only pirfenidone is reimbursed for IPF
Many people assume Ofev (nintedanib) is also covered for IPF, but as of 2026 the only antifibrotic reimbursed for the IPF indication in Korea is pirfenidone (Pirespa).
Nintedanib (Ofev) entered reimbursement in May 2025, but only for systemic-sclerosis-associated interstitial lung disease (SSc-ILD) and progressive pulmonary fibrosis (PPF) — IPF is excluded.
Why is Ofev non-covered for IPF?
- • Because pirfenidone (Pirespa) already covers IPF under a risk-sharing agreement, the drug reimbursement committee did not grant Ofev a separate IPF benefit.
- • So an IPF patient taking Ofev pays 100% of the drug cost as non-covered (about KRW 19 million a year).
- • The special case (rare-disease 10%) and the out-of-pocket ceiling apply only to covered items, so even a registered IPF patient gets no benefit on the non-covered Ofev cost.
- • This calculator automatically treats Ofev as “IPF non-covered” and shows a warning badge.
In short, to minimize IPF treatment cost, pirfenidone — which is both covered and eligible for the special case — is considered first.
If pirfenidone’s side effects (photosensitivity, GI upset) are intolerable or there is another clinical reason, some patients accept non-coverage and use nintedanib, so the choice should be made with your physician.
The IPF special case is 10%, not 5% (J84.11 / V236)
Many people confuse this with the cancer special case (5% copay), but the special case for idiopathic pulmonary fibrosis is a rare disease, so the copay is 10%.
Even so, insurance covers 90% of the covered drug cost, which cuts the burden sharply.
Rare-disease special case — key points
- • Idiopathic pulmonary fibrosis (J84.11): rare-disease special mark V236, copay 10%
- • Scope: 10% of the total covered cost for the covered drug (pirfenidone), outpatient, inpatient, and pharmacy dispensing
- • Registration period: valid for 5 years from registration, with re-registration if the disease persists
- • Filing deadline: apply within 30 days of confirmed diagnosis for the rate to be backdated to the diagnosis date
- • Difference from cancer: cancer/severe-burn special cases are 5%, but IPF, as a rare disease, is 10%
The basis is the National Health Insurance Act Article 44 and Enforcement Decree Article 19(1) Annex 2, and 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.
The special mark V236 and ICD code J84.11 were cross-checked against the National Law Information OPEN API and the KDCA rare-disease helpline.
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.
How much does the drug cost?
Antifibrotics are taken as several tablets daily over the long term, so the total drug cost is large.
But with coverage and the special case, the real burden falls sharply.
- • Pirespa (pirfenidone): about KRW 3,294 per 200 mg tablet (originator), 9 tablets/day maintenance → about KRW 10.8 million/year at 100%
- • Pirfenidone generic: about KRW 2,200 per 200 mg → about KRW 7.2 million/year (estimate), lower
- • Ofev (nintedanib): about KRW 26,220 per 150 mg capsule, 2 capsules/day → about KRW 19.1 million/year (non-covered for IPF, fully out of pocket)
Applying the rare-disease special case (10%) to pirfenidone cuts the annual drug copay to around KRW 1 million, and the out-of-pocket ceiling caps it at your income-tier limit.
By contrast, Ofev is non-covered for IPF, so the special case and ceiling do not apply and the roughly KRW 19 million a year is paid out of pocket (private indemnity insurance may reimburse part of it).
Out-of-pocket ceiling and medical-expense tax credit
IPF requires long-term medication, 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 or for non-covered items, the ordinary KRW 7,000,000 annual cap applies
Non-covered drug cost (Ofev) is not eligible for the ceiling refund, but as a treatment drug it is eligible for the medical-expense tax credit.
Amounts refunded by the ceiling and reimbursed by private insurance must be excluded from the tax credit to avoid double-counting.
How to use this calculator
Step 1: Choose the drug
Pick pirfenidone (Pirespa), a pirfenidone generic, or nintedanib (Ofev), then set coverage and treatment period.
Choosing Ofev is computed automatically as IPF non-covered with a warning badge.
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 IPF special-case copay 5% like cancer?
A. No. Cancer is a serious-illness special case at 5%, but idiopathic pulmonary fibrosis (J84.11 / V236) is a rare-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 Ofev (nintedanib) covered for IPF too?
A. Not for IPF. Ofev is reimbursed only for SSc-ILD and progressive pulmonary fibrosis (PPF); IPF is excluded.
The only antifibrotic covered for IPF is pirfenidone (Pirespa); using Ofev for IPF means paying about KRW 19 million a year fully out of pocket.
Q. When is pirfenidone covered?
A. For IPF confirmed by a UIP pattern on HRCT or biopsy, when reimbursement criteria are met — for example FVC ≤ 90% and DLco ≤ 80%.
A 2019 revision extended coverage to more severe patients; the exact criteria follow HIRA reimbursement standards and your physician’s judgment.
Q. Will antifibrotics make my lungs better again?
A. Antifibrotics are not a cure; they slow the decline in lung function (FVC).
They cannot reverse already-scarred lung, but by slowing progression they aim to improve survival and quality of life.
Q. Can private insurance reimburse the drug cost?
A. Therapeutic antifibrotic drug cost is 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, generics, and risk-sharing agreements; this calculator uses 2026 public drug prices. Generic prices are estimates.
- Coverage is individual: whether the criteria (FVC, DLco, UIP pattern) are met depends on the patient, so confirm with your physician and HIRA.
- Ofev is non-covered for IPF: nintedanib (Ofev) is not reimbursed for IPF, so the special case and ceiling do not apply.
- 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 IPF antifibrotic cost now
Enter the drug, coverage, special case, and income tier to see the annual real burden of pirfenidone and nintedanib.
Compare the special-case 10% vs 5% (planned), the out-of-pocket ceiling refund, and covered vs non-covered in one place.