Reported by Zhan Chien-Fu from Taipei

There are over 10 thousand new cases of lung cancer every year.  For them, a genetic test and an NHIA’s prior approval are required to access NHI-reimbursed targeted therapy.  The whole application process takes about 1 month.  During the process, patients are inflicted with pains and worries.  In the “Health Forum” organized by the United Daily News and the Academia Sinica recently, health experts urged the government to streamline the application process.  In reply to this request, the NHIA decided to change the policy from prior assessment to post assessment so that patients can have an early access to treatments.

Lung cancer has been the number one cause of death in Taiwan since 2007.  As its early symptoms are not significant, about 80% patients are already in stage 3 or stage 4 when being diagnosed.  In the “Health Forum”, many scholars and experts put forward valuable suggestions on preventing cancers.  They urged the government to include high-risk group of lung cancer into the target for low-dose CT screening.  They also suggested that the NHIA should streamline the assessment process for prior-approval.

Many lung cancer patients are worried about being rejected the targeted therapy while waiting for their genetic test results.  Dr Tsai Jun-Min of the Taipei VGH pointed out that targeted therapies for lung cancer, such as Tarceva, Iressa and Afatinib, are only effective in patients with positive genetic test results.

The genetic test results affect a physician’s decision on lung cancer treatment strategies.  “Patients are fighting against time; but the NHIA’s requirement of a prior approval does not help,” said Dr Tsai.  It takes 10 days to get the genetic test results and a fortnight to go through the NHIA’s approval process.  “Patients are inflicted with worries and uncertainties,” said Dr Tsai.

Kuo Chui-Wen of the NHIA expressed that, according to current regulations, the NHIA has to reply to an application for prior approval within 2 weeks of receiving the application.  “In practice, the waiting is not too long,” said Kuo.

Kuo expressed that the NHIA has been reviewing the regulations concerning prior approval.  Considering that a genetic test is required to justify the use of targeted therapy for lung cancer and colorectal cancer and the cost of such tests is covered by pharmaceutical manufacturers, the NHIA is now contemplating allowing doctors to use EGFR targeted therapies on a post-approval basis. A proposal will be submitted to the NHI Joint Meeting for PBRS.  If the process goes smoothly, the new policy can be put into practice by the end of this year.

【2014-7-29 / United Daily News】