OBJECTIVES:  Having maintained close association with China through the ages, a number of traditional Chinese medicine hospitals have prevailed in South Korea despite abundance of western medicines. Given this prevalence of herbal medicinal therapy and the increasing healthcare expenditure, the purpose of this research is to explore the feasibility of formally establishing guidelines and conducting pharmacoeconomic evaluations for coverage selection of traditional Chinese medicine from the perspective of decision makers in the Republic of Korea.  METHODS:  Research was conducted, using qualitative telephone and email-based interviews with individuals involved in Health Insurance Review & Assessment Service (HIRA) and KOLs in South Korea in order to gain a broad range of perspectives on the topic. The interviewees were asked to share their opinions on the significance and viability of developing formal guidelines and performing economic evaluations for traditional herbal medicines. Moreover, they were asked to identify critical issues around applying established pharmacoeconomic guidelines to traditional medicinal therapy.  RESULTS: In the primary research, the majority of interviewees agreed on the importance of conducting pharmacoeconomic evaluations for traditional medicine. They recognised that a great amount of herbal medicine is produced and consumed. Patients pay for this medicine as out-of-pocket expense, although the outcomes are not well measured and understood by either the government or the public. Furthermore, they acknowledged that existing pharmacoeconomic guidelines may not always be appropriate for making coverage decisions for these herbal treatments. Finally, they expected that separate guidelines specifically targeted at traditional medicine may develop, but not in a very near future.   CONCLUSIONS: Given the extensive use of herbal medicine by the public, using pharmacoeconomic evaluation for reimbursement decision may encourage patients and physicians to choose more cost effective treatments and thus prevent the dramatic increase in total healthcare expenditure without demonstrated improvement in health outcomes.