Treatment of hepatitis C virus (HCV) infection is now facing a breakthrough arising from successful development the direct acting antivirals (DAA). Pegylated interferon alpha and ribavirin combination therapy for 24-48 weeks was a longstanding standard therapy despite high rate of adverse events and relatively low efficacy, showing sustained virological response (SVR) rate of 60% in genotype 1 and of 80% in genotype 2 HCV infected patients in South Korea. The first approved DAA therapy in Korea was daclatasvir and asunaprevir combination therapy for 24 weeks in 2015 with expected SVR rate of 80-90%. It is reimbursed for HCV genotype 1b chronic hepatitis and compensated cirrhosis patients in whom resistance associated variation (RAV) was not detected in NS5A region of HCV genome (L31 or Y93 codon). The next approved DAA therapy is ledipasvir/sofosbuvir fixed dose combination in one tablet and only reimbursed for genotype non-1b patients with expected SVR rate of 90-99% using 12-24 week regimen with or without ribavirin since May 2016. For genotype 2 infection, sofosbuvir and ribavirin combination for 12 weeks is approved with expected SVR rate of 95%. Under the resource restraint, DAA therapy is strictly regulated by National Health Insurance (NHI). However, at least for genotype 1b patients with baseline NS5A RAV or with decompensated cirrhosis, ledipasvir/sofosbuvir or other new DAA therapy should be reimbursed by NHI. In addition to the high cost, drug-drug interactions, and development of resistance associated mutants in DAA therapy are problems to overcome.