Overview
- The government approved a revised plan on Dec. 24 to raise monthly out-of-pocket caps under the high-cost medical expense scheme by about 7% to 38% through phased changes in August 2026 and August 2027.
- For households with annual income around ¥3.7 million to ¥7.7 million, the monthly cap will move from about ¥80,100 to about ¥85,800 in August 2026, with a new ¥6.5 million to ¥7.7 million bracket reaching about ¥110,400 in August 2027.
- A new annual ceiling begins in August 2026 for long-term treatment, set at ¥530,000 for incomes roughly ¥2 million to ¥7.7 million, while the existing frequent-use protection is largely maintained.
- Cancer and rare-disease groups issued a joint statement praising the new safeguards yet arguing the monthly increases are not sufficiently restrained, warning that some patients could forgo care.
- The package also raises the special outpatient caps for people 70 and older and introduces added cost sharing for OTC-similar drugs and brand-name medicines when generics are available.