Japan's Central Social Insurance Medical Council (Chuikyo) has approved groundbreaking changes to the national health insurance system that will significantly impact healthcare access for both Japanese citizens and foreign residents. The February 13, 2026 decisions include coverage for a ¥300 million gene therapy treatment and expanded palliative care services beyond cancer patients. The most expensive treatment ever covered under Japan's public insurance system, the gene therapy drug "Elevidys" (エレビジス), will now be available to patients with Duchenne muscular dystrophy, a progressive muscle-weakening disease. According to NHK, the treatment has been approved at a price of approximately ¥304.97 million (roughly $2 million USD) per administration. This marks a historic moment in Japanese healthcare, as it represents the country's most costly publicly insured medical treatment to date. For foreign residents enrolled in Japan's national health insurance system, this development means access to cutting-edge genetic therapies that would be prohibitively expensive in many other countries. Under Japan's insurance structure, patients typically pay 30% of medical costs, though high-cost medical expense programs can reduce the burden significantly for treatments exceeding certain thresholds. This safety net applies equally to foreign residents who maintain valid insurance enrollment. The Chuikyo also approved a significant expansion of palliative care coverage under the diagnostic fee schedule. Previously, palliative care reimbursement was limited primarily to cancer patients and a small number of other conditions. According to NHK's report on the decision, the coverage will now extend to patients with end-stage renal failure and other serious conditions. This change recognizes that pain management and quality-of-life care should not be restricted by disease category. For expats living in Japan, this palliative care expansion is particularly relevant for those managing chronic conditions or caring for elderly family members. The broader coverage means that patients suffering from kidney disease, heart failure, and other progressive illnesses can now access specialized pain management and comfort care services that were previously unavailable or not covered by insurance. These services typically include symptom management, psychological support, and coordination of care across medical teams. These announcements came alongside other healthcare system changes, including increased reimbursement rates for medical institutions that raise staff wages and a new "price response fee" that can be added to basic consultation and hospitalization charges. While these changes aim to support healthcare workers amid rising costs, they will also result in modest increases in out-of-pocket expenses for patients at the clinic or hospital window. Foreign residents should be aware that maintaining continuous enrollment in Japan's national health insurance or employee health insurance is essential to accessing these benefits. Those who have recently arrived in Japan or changed employment status should verify their insurance coverage is active and up to date. The insurance system does not discriminate based on nationality, meaning that any legal resident with valid insurance enrollment can access the same treatments and services as Japanese citizens. The gene therapy approval demonstrates Japan's commitment to providing access to advanced medical treatments despite their extraordinary costs. However, patients considering such treatments should consult with their medical providers about eligibility criteria, as Elevidys is specifically indicated for Duchenne muscular dystrophy patients meeting certain clinical requirements. For practical purposes, expats should keep several points in mind: maintain continuous insurance coverage, understand that while the national system covers these treatments, initial consultation and diagnostic costs still apply, and be prepared to navigate the referral system, as access to specialized treatments typically requires recommendations from primary care physicians or specialists. These policy changes reflect Japan's evolving approach to healthcare coverage, balancing fiscal responsibility with access to innovative treatments and comprehensive end-of-life care. For the foreign community, they reinforce the value of Japan's universal healthcare system and the importance of maintaining proper insurance enrollment.