Study Session on Health Insurance Act Revision: Will Increased Burden for "OTC-like Drugs" Truly "Reduce Burden on the Working Generation"? [Kyosairen]

Pal System Kyosai Cooperative Federation (Headquarters: Shinjuku-ku, Tokyo; President: Atsushi Shibusawa) held its second "Medical and Health Disparity Study Session" at its Higashi Shinjuku headquarters on Thursday, May 7th, with 29 participants including online viewers. They invited a lecturer from the National Federation of Health Insurance Societies (Zenkoku Hoken-i Renmei) (Headquarters: Shibuya-ku, Tokyo; President: Tomoo Takeda) to learn about the impact of the additional burden for OTC (over the counter) equivalent drugs due to the Health Insurance Act revision, which is expected to pass in the current Diet session.

1,100 items that everyone relies on will be targeted

At the study session, Shogo Honnami, Deputy Secretary-General of Zenkoku Hoken-i Renmei, explained the impact of the additional burden for OTC-like drugs, scheduled to begin in March 2027. OTC-like drugs have almost the same ingredients and efficacy as over-the-counter drugs but require a prescription. For 1,100 drug items using 77 ingredients, such as the pain reliever "Loxonin" and the allergy medication "Allegra," a special charge equivalent to 25% of the drug price will be required in addition to the existing self-payment amount for insured medical care.

▲Mr. Honnami expresses concern about endless increases in medical expenses.

The government states that it aims to reduce rapidly increasing national medical expenses, which amounted to 48 trillion yen in FY2024, and reduce insurance premiums per person, by ensuring fairness with patients who purchase over-the-counter drugs for symptomatic treatment of pain, itching, fever, etc. The cost of OTC-like drugs is 90 billion yen, which is a 0.18% reduction of the total national medical expenses. When converted per person, this amounts to a reduction of 400 yen per year, or 33 yen per month.

The 1,100 targeted items are drugs everyone uses daily, including pain patches, pain relievers, anti-allergy drugs for hay fever, moisturizers, and steroids. Conditions requiring moisturizers and steroids, such as atopic dermatitis, are common among the working generation, for whom continuous use of medication is essential for social life, including work and school.

Hay fever, which is said to affect one in two Japanese, can lead to reduced labor productivity if medication is not taken for several months, depending on the type of pollen. There is also an estimate that while the burden is reduced by 33 yen per month, receiving a prescription for oral, ophthalmic, and nasal OTC-like hay fever medications would result in an increased burden of 1,500 yen per month.

The vicious cycle created by self-diagnosis

Mr. Honnami explains, "People who self-treat initial symptoms of illness like fever, cough, or pain with over-the-counter drugs are mainly working-age individuals who are too busy to see a doctor. If the government's message, which recommends the use of over-the-counter drugs for fairness, is misunderstood, it will create a vicious cycle of avoiding doctor visits and self-diagnosis."

If people suppress symptoms with over-the-counter drugs based on self-diagnosis without consulting a medical institution, it could lead to the progression of serious illnesses or the spread of infections. For example, continuously taking over-the-counter stomach pain medication and overlooking early symptoms of stomach cancer could lead to a severe condition, ultimately increasing medical costs. If initial symptoms of an infection, which cannot be self-diagnosed, are suppressed with over-the-counter drugs to continue social life, it could trigger mass infections and even bring social functions to a halt.

"Even if the additional burden for OTC-like drugs temporarily reduces insurance premiums by 33 yen per person per month, it is a poor cost-performance policy that will lead to increased societal medical expenses in the future," says Mr. Honnami. He also criticized the decision to revise the bill to increase the burden without hearings from medical professionals or patient groups, and cited voices from an online survey conducted in March 2026 targeting 8,098 people.

Giving up on employment and daily life

Many voices expressed concerns about avoiding doctor visits and maintaining daily life, such as a 20-something atopic patient saying, "With a low take-home pay, I have no choice but to cut food expenses or give up treatment." And a parent with young children stating, "Amid rising prices, the increased cost of my chronic illness medication and medication for all family members, including children, directly hits our household budget."

There are also voices from patients who rely on OTC-like drugs to maintain their daily lives: "To control atopic dermatitis, a large amount of moisturizers and steroids are necessary, and if I run out, I can't even manage daily life, let alone work." "Nursery teachers, who constantly bend down to children's eye level and carry or piggyback them, cannot do without pain patches for chronic back pain."

Lower back pain and hernias are common occupational diseases among manual laborers and drivers in construction sites, and pain-relieving patches are essential for continued employment. If allergies such as hay fever lead to a lack of concentration or falls due it dizziness, it could result in serious accidents. This situation could run counter to the Industrial Safety and Health Act promoted by the Ministry of Health, Labour and Welfare (MHLW).

MHLW states that after the law passes, they will consider considerations for patients with specific diseases such as intractable diseases and cancer, and for children, but not for professions prone to chronic diseases. There is a possibility that essential workers who support society with low wages, such as caregivers, childcare workers, and manual laborers, may find it difficult to maintain their health due to the increased burden of OTC-like drugs, leading to labor shortages.

All Keywords: Health Insurance Act Revision, OTC-like drugs, Reducing burden on the working generation.