The NHIA is currently preparing for the reimbursement of Next Generation Sequencing (NGS) tests, initially covering 19 cancers with different eligibility conditions to be established by experts. A patient can only use the NHI-reimbursed NGS test once in a lifetime for each type of cancer. The NHIA expects to launch the NGS in May and plans to allocate a budget of NT$0.6-1 billion to cover NGS tests for this year, as indicated by Dr Shih Chung-Liang, the Director-General of the NHIA.

Dr Shih expressed that 830,000 patients received cancer treatments in 2022, incurring a total drug fee of NT$39.2 billion of which targeted therapies accounted for 61.7%. Currently, the NHIA offers 26 target therapies, targeting 11 gene loci for 10 different types of cancers.

Dr Shih said that the NGS is able to test various gene loci at the same time.  The NHIA plans to use the NGS for testing 19 cancers, including non-small cell lung cancer, triple-negative breast cancer, ovarian cancer, fallopian tube cancer, primary peritoneal cancer, intrahepatic cholangiocarcinoma, prostate cancer, etc.

According to Dr Shih, the NHIA has plans for three reimbursement schemes: payment for testing BRCA1 and BRCA2, payment for testing a small set of under 100 of the most basic gene loci, and payment for testing a large set of over 100 gene loci. The NHIS will provide a fixed payment, and patients have the option of balance billing for additional tests if required. It is mandatory for NGS test results to be uploaded to the National Health Research Institute’s databank; failure to do so will result in the rejection of the reimbursement claim.

The NHIA has scheduled an expert meeting on February 6 to discuss the conditions for the NGS test for each eligible cancer.  The NHIA has set an initial annual budget of NT$0.6-1 billion which could be increased next year. 

【2024-01-21 / Liberty Times】