Pharmaceutical News
NHI plans to impose co-payment on expensive drugs to reduce patients’ burden

Cancer has been the number one cause of death in Taiwan for 40 consecutive years, and, as a result, the expenditure on cancer drugs is spiralling up year after year.   In 2022, the total cost for treating 830, 000 cancer patients reached NT$133.4 billion, including NT$39.2 billion spent on cancer drugs, despite the fact that it represents the first decline in the growth rate of cancer drugs in nearly a decade.  As the number of cancer patients is increasing, the NHIA is working to accelerate the inclusion of new cancer drugs in the NHI coverage by considering the implementation of a cost-sharing scheme (co-payment) for expensive drugs, such as cancer drugs, new drugs and orphan drugs.  A co-payment cap will be set to reduce the financial burden on the public.

For example, under a co-payment scheme with a 5% cap, a cancer patient who opts for a targeted therapy which costs NT$100,000 a month will have to pay just an additional NT$5,000 a month for the medication.   The NHIA expressed that the details are still under discussion, and they are currently gathering opinions from all stakeholders.

Shih Chung-Liang, the Director General of the NHIA, stated that from 2014 to 2022, the cancer treatment cost has been increasing year by year, from NT$78.3 billion to NT$133.4 billion.  Among them, cancer drug fees have increased from NT$18 billion to NT$39.2 billion, up by 230%.  On average, cancer drug fees have an annual growth of 10%, far higher than the average 4% growth of the NHI global budget.

The government has allocated over NT$800 billion for the 2023 NHI global budget, including a total drug fees of NT$230 billion. Cancer drugs account for more than one-sixth of this budget, amounting to about NT$40 billion.  According to Shih, there are about 830,000 cancer patients who are currently receiving treatments, and about 120,000 new cases are added every year.  Hence, the expenses on cancer drug continue to grow. 

Based on the NHIA’s data on cancer drug fees in 2023, targeted therapies accounted for NT$24.8 billion (61.7%), followed by chemotherapies at NT$86.5 billion (21.5%), immune modulators at NT$8.3 billion (2.1%) and radioactive drugs at NT$2.8 billion (0.7%).

To accelerate the inclusion of new cancer drugs in the NHI coverage, the NHIA’s short-term policies include to accelerate NHI listing and reimbursement applications and to establish an exit mechanism, for example to provide a 2-year temporary listing for new drugs for the confirmation of their effectiveness.    One of the NHIA’s long-term policies is to promote the co-payment system on cancer drugs, new drugs and orphan drugs, for example to work out a cost sharing program with a payment cap.  The NHIA is collecting public comments and evaluating the feasibility.  In addition, the NHIA is also contemplating the establishment of an "independent and diversified support fund" for expensive drugs.

Another approach is to collaborate with private insurance companies to improve the NHI coverage.  Shih Chung-Liang expressed that private health insurance policies exclude those who are already diagnosed with diseases, and the policies are usually sold as an add-on to other insurance policies.  The NHIA will discuss with insurance companies the possibility of developing a health insurance policy as an add-on to the NHI. 

【2023-05-01 / United Daily News】