Medical Expense Subsidy Procedures for Designated Intractable Diseases (Ophthalmology)
1. What is the Medical Expense Subsidy System for Intractable Diseases?
Section titled “1. What is the Medical Expense Subsidy System for Intractable Diseases?”The Act on Medical Care for Patients with Intractable Diseases (hereinafter referred to as the Intractable Disease Act) was enacted in January 2015. Based on this law, medical expense subsidies are provided to patients with “designated intractable diseases” specified by the Ministry of Health, Labour and Welfare 1).
Designated intractable diseases are those with a certain number of patients in Japan, unknown causes, unestablished treatment methods, requiring long-term care, and for which objective diagnostic criteria have been established. As of April 2026, 348 diseases are designated as intractable diseases, including many that require ophthalmological management 2).
The main purposes of the system are as follows:
- Reduction of out-of-pocket medical expenses: Limits the high long-term medical cost burden to a monthly cap based on income category.
- Promotion of continuous medical management: Supports regular hospital visits and treatment guidance to suppress disease progression.
- Development of designated medical institutions: Applies subsidies to medical care at institutions designated by prefectures (designated medical institutions).
Subsidies apply to medical examinations, medication costs, and home-visit nursing at designated medical institutions. By presenting the recipient certificate, subsidies can be received at any designated medical institution nationwide.
Yes, it does. Many diseases requiring ophthalmological management are included as designated intractable diseases, such as retinitis pigmentosa, congenital glaucoma, Behçet’s disease (ocular symptoms), sarcoidosis (ocular symptoms), Stevens-Johnson syndrome, and gelatinous drop-like corneal dystrophy. Check the list of designated intractable diseases on the Intractable Disease Information Center website or consult your doctor to see if your disease is covered.
2. Main designated intractable diseases in the ophthalmology field
Section titled “2. Main designated intractable diseases in the ophthalmology field”Among designated intractable diseases, representative diseases requiring ophthalmological management and eye examinations are shown below. These are only representative examples, and there are many other ophthalmology-related designated intractable diseases 2).
| Disease name | Main ophthalmological problems | Disease number (example) |
|---|---|---|
| Retinitis pigmentosa | Night blindness, visual field constriction, blindness | 90 |
| Congenital glaucoma (developmental glaucoma) | Elevated intraocular pressure, optic neuropathy | 125 |
| Gelatinous drop-like corneal dystrophy | Corneal opacity, decreased vision | 253 |
| Stevens-Johnson syndrome | Corneal epithelial disorder, symblepharon | 38 |
| Behçet’s disease (ocular symptoms) | Recurrent uveitis, chorioretinal atrophy | 56 |
| Sarcoidosis (ocular symptoms) | Granulomatous uveitis, glaucoma | 84 |
| Juvenile Idiopathic Arthritis (JIA) | Uveitis / Band keratopathy | 107 |
| Neurological diseases with ocular movement disorders | Ocular movement disorder / Visual impairment | Various |
In addition to the above, there are many designated intractable diseases of retinal degeneration, such as retinitis punctata albescens, vitelliform macular dystrophy, congenital retinoschisis, Leber congenital amaurosis, and choroideremia. The disease numbers are based on the notification of the Ministry of Health, Labour and Welfare and may be revised 2).
Intractable Disease Information Center (https://www.nanbyou.or.jp/）のウェブサイトで指定難病一覧を確認できる。主治医に相談することも有効であり、担当の眼科医または難病指定医が該当の有無を判断する。疑わしい場合は保健所や都道府県の難病相談・支援センターに問い合わせることもできる。
3. Eligible for Subsidies and Monthly Upper Limit of Copayment
Section titled “3. Eligible for Subsidies and Monthly Upper Limit of Copayment”Medical Care Eligible for Subsidies
Section titled “Medical Care Eligible for Subsidies”Medical expense subsidies cover medical care related to designated intractable diseases, including the following:
- Outpatient consultation fees: Consultation fees, procedure fees, and examination fees at designated medical institutions
- Hospitalization costs: Medical fees during hospitalization (part of the meal service fee is out-of-pocket)
- Medication costs: Prescription drugs related to the designated intractable disease
- Home-visit nursing: Services provided by a home-visit nursing station (if designated)
- Medical care/rehabilitation: Related to treatment of designated intractable diseases
Monthly Maximum Copayment
Section titled “Monthly Maximum Copayment”The monthly maximum copayment varies by income category. In some cases, the income of family members covered by the same health insurance is combined to determine the category3).
| Income Category | Monthly Maximum (Outpatient + Inpatient) | Inpatient Meal Costs |
|---|---|---|
| Public Assistance | 0 yen | Fully exempt |
| Low Income I (Exempt from municipal inhabitant tax: annual income ≤ 800,000 yen) | 2,500 yen | Copayment required |
| Low Income II (Exempt from municipal inhabitant tax: other) | 5,000 yen | Copayment required |
| General Income I (Municipal inhabitant tax taxable: less than 71,000 yen) | 10,000 yen | Copayment required |
| General Income II (Municipal inhabitant tax taxable: 71,000 yen or more) | 20,000 yen | Copayment required |
| Higher Income (Municipal inhabitant tax taxable: 251,000 yen or more) | 30,000 yen | Copayment required |
| Inpatient Living Medical Expenses | Reduction available for high-cost and long-term cases | Reduction measures available |
The monthly upper limit is managed on a monthly basis. Medical expenses exceeding the upper limit stated on the recipient certificate are covered by public funds. If you visit multiple designated medical institutions, the copayment amounts at each institution are combined and managed (recorded on the “Copayment Upper Limit Management Form”).
Intractable Disease Outpatient Guidance and Management Fee
Section titled “Intractable Disease Outpatient Guidance and Management Fee”The Intractable Disease Outpatient Guidance and Management Fee can be claimed as insured medical treatment when providing planned outpatient guidance and management to patients holding a Specific Medical Expenses (Designated Intractable Diseases) Recipient Certificate. This also applies when an ophthalmologist performs ophthalmic management for designated intractable diseases (e.g., regular management of uveitis, follow-up of retinal degenerative diseases).
4. Required Documents and Procedures for Application
Section titled “4. Required Documents and Procedures for Application”Application Flow
Section titled “Application Flow”The flow from application to issuance of the recipient certificate is shown below.
| Step | Details | Responsible Person |
|---|---|---|
| 1 | Preparation of a medical certificate (clinical survey individual form) by a designated physician for intractable diseases | Designated physician for intractable diseases (ophthalmology, etc.) |
| 2 | Preparation of required documents | Patient/Family |
| 3 | Application to the prefectural office (public health center, health center, etc.) | Patient/Family |
| 4 | Review and certification by the prefecture | Prefecture |
| 5 | Issuance of the Specific Medical Expenses (Designated Intractable Diseases) Recipient Certificate | Prefecture |
| 6 | Present the recipient certificate when visiting a designated medical institution | Patient |
It usually takes about 1 to 3 months from the review to the issuance of the recipient certificate. Since there is a system that applies subsidies retroactively to the date of application, it is recommended to apply promptly.
Required Documents for Application
Section titled “Required Documents for Application”Generally, the following documents are required. Details may vary by prefecture or public health center, so it is advisable to check in advance.
- Clinical Survey Individual Form (Medical Certificate): A prescribed medical certificate completed by a designated physician for intractable diseases.
- Copy of Health Insurance Card: Copies for all patients and insured members may be required.
- Certificate of Residence: For all household members (to verify household status).
- Income certificate / municipal inhabitant tax certificate: Used to confirm income category
- Application form: Form prescribed by each prefecture
- Other: If you have a disability certificate or medical care certificate, a copy may be required
Only a “Designated Physician for Intractable Diseases” appointed by the prefectural governor can write it. There are two types: “Designated Physician for Specified Intractable Diseases” and “Cooperating Physician for Intractable Diseases.” The former can write medical certificates for definitive diagnosis and new applications, while the latter is limited to renewal applications. Check with your medical institution whether your primary care physician has the qualification as a Designated Physician for Intractable Diseases.
5. Validity Period and Renewal of the Recipient Certificate
Section titled “5. Validity Period and Renewal of the Recipient Certificate”Validity Period
Section titled “Validity Period”The validity period of the recipient certificate is generally one year (from the date of issuance to the end of the same month of the following year). Note that if you do not apply for renewal every year, the subsidy will be interrupted.
The main points for renewal application are as follows.
- Renewal deadline: Applications can be made approximately 3 months before the expiration date. Early procedures are necessary to avoid expiration.
- Medical certificate required for renewal: A clinical survey individual form for renewal by a “Cooperating Physician for Intractable Diseases” is also acceptable.
- If symptoms change: The income category or subsidy content may change due to improvement or worsening of symptoms.
- When address or insurance changes: If you move or change jobs, prompt change procedures are necessary.
Handling When Symptoms Improve
Section titled “Handling When Symptoms Improve”For mild cases that no longer meet the severity criteria for specified intractable diseases, there is a special provision that allows continued medical expense subsidies if the patient continues to pay high medical costs (mild case with high costs). Specifically, if the total monthly medical expenses (full 100% amount) exceed 33,330 yen, the patient can continue to receive subsidies as a mild case with high costs3).
Consultation and Inquiry Desk
Section titled “Consultation and Inquiry Desk”- Public Health Center: Application desk, document reception, and screening
- Prefectural Intractable Disease Consultation and Support Center: Explanation of the system, daily living consultation, and peer support among patients
- Municipal Office (Health Section, etc.): Document collection, obtaining resident certificates and tax certificates
Even if symptoms improve and no longer meet the severity criteria, if the total monthly medical expenses exceed 33,330 yen (in 10% equivalent), you may continue to receive subsidies as a “mild but high-cost case.” It is recommended to consult with your designated physician for intractable diseases or the public health center to see if your situation qualifies.
6. Relationship with Other Support Systems
Section titled “6. Relationship with Other Support Systems”The medical expense subsidy for intractable diseases can be used alone or combined with other systems to enhance living support.
Overlapping Application with Physical Disability Certificate
Section titled “Overlapping Application with Physical Disability Certificate”Even if you have an intractable disease, if your ophthalmological impairment (visual acuity impairment, visual field impairment, etc.) meets certain criteria, you can apply for a Physical Disability Certificate (visual impairment). The medical expense subsidy for intractable diseases and welfare services under the Physical Disability Certificate can be used concurrently, and obtaining one does not invalidate the other.
Obtaining a Physical Disability Certificate (Grade 1 or 2, etc.) may allow you to access additional services such as:
- Provision of daily living aids: Magnifying readers, braille displays, tinted glasses, etc. (handled by municipalities)
- Provision of assistive device costs: Artificial eyes, contact lenses, etc. (under certain conditions)
- Various public transportation discounts and tax incentives
Even without a Physical Disability Certificate, patients with intractable diseases may be eligible for some daily living aid provision systems.
Relationship with Disability Pension
Section titled “Relationship with Disability Pension”If significant difficulties in daily life or work arise due to visual impairment, etc., it is possible to apply for disability pension (National Pension, Employees’ Pension). The medical expense subsidy for intractable diseases and disability pension can be received concurrently, and there is no mechanism by which receiving one reduces the other.
Relationship with Long-Term Care Insurance and Home Nursing
Section titled “Relationship with Long-Term Care Insurance and Home Nursing”For patients with intractable diseases aged 65 or older, long-term care insurance takes priority, but there are cases where both the specific medical expense subsidy for designated intractable diseases and long-term care insurance can be utilized. For patients aged 40 to 64 with intractable diseases, depending on the type of disease, they may fall under specific diseases covered by long-term care insurance and be able to use long-term care services.
Both can be used. The medical expense subsidy for intractable diseases reduces the out-of-pocket cost for ophthalmological treatment, while the Physical Disability Certificate serves as the basis for receiving welfare services such as provision of daily living aids, payment for assistive devices, and discounts on public transportation. They are independent systems, and using one does not affect the other. If the degree of ophthalmological disability meets the certification criteria for the Physical Disability Certificate, it is recommended to consult with your primary care physician and consider applying.