Pharmaceutical News
Copayment revisions to accelerate National Health Insurance coverage for new drugs

By National Health Insurance Administration Director General Lee Po-chang


A recent survey by the HOPE Foundation for Cancer Care showed that 75 percent of cancer patients have paid out-of-pocket for treatment. Among them, 20 percent paid more than NT$1 million in out-of-pocket expenses, with only 2 percent saying that their treatment was entirely covered by the National Health Insurance (NHI). The outcome suggests that the inadequacies of the NHI is no longer an issue that can be avoided. However, from the perspective of the NHI global budget, most prescription medicines are covered by the NHI.


In 2021, the number of cancer patients tallied around 800,000, whose medical expenses totaled NT$130.1 billion, representing one eighth of the NHI global budget. In recent years, the NHI new drug budget has been limited at between NT$2 billion and NT$2.5 billion. Estimates for the 2022 global budget show that the demand for new drugs and new indications have surged to NT$6.6 billion, among which NT$5.5 billion are oncology drugs.


As Taiwan’s NHI has a high level of overlap with commercial health insurance products, it is hoped that through information disclosure, the industry can devise new product offerings help ease the burden on cancer patients. Meanwhile, the NHIA has also proposed copayment revision aimed preventing the public from seeking unnecessary health care. Estimates show that if each patient reduces makes one less medical appointment each year, around 37.8 billion medical points can be saved per annum, in which 11.4 billion points are from drug prescriptions. Just 40 percent of the sum of the 11.4 billion medical points saved and the NT$2.5 billion budget for new drugs can provide ample funding to add new cancer drugs to the NHI fee schedule, as well as improving compensation for health care professionals.


By cutting expenditures on unnecessary diagnostic tests and drug prescriptions, NHI finances can be improved, while also accelerating the timetable in which new drugs, medical devices and therapeutics can be included on the NHI fee schedule, to the benefit of all.


[2022-7-23/United Daily News]