The NHIA has announced the results of the meeting of the Joint Establishment of NHI Drug Dispensing Items and Fee Schedule. The meeting concluded with a decision to allocate over NT$5.9 billion to add and expand coverage for various medications, primarily for the treatment of chronic renal diseases, osteoporosis, and cancers. These changes are expected to take effect as early as February next year, benefiting over 310,000 people.
Taiwan has nearly 100,000 people undergoing kidney dialysis. Treating chronic kidney diseases costs the NHI over NT$50 billion annually, making it the most expensive disease to manage. In response, the Joint Establishment Meeting decided to expand coverage for SGLT2 inhibitors, originally developed to control blood sugar in diabetes. Clinical trials have demonstrated that these drugs can also slow the progression of renal disease and lower the risk of heart failure. The extended coverage, now including patients with an estimated glomerular filtration rate (eGFR) between 25% and 60%, is expected to effectively prevent disease progression and reduce the number of patients requiring dialysis.
Dr. Shih Chung-Liang, Director-General of the NHIA, emphasized that patients cannot rely solely on medications but must also take responsibility for their own health. The extended reimbursement scope includes a condition requiring patients to participate in either the “Integrated Care Scheme for Early-Stage Chronic Renal Diseases” or the “Care and Education Scheme for Pre-End-Stage Renal Diseases.” To qualify for NHI-reimbursed treatments, patients must commit to making lifestyle changes, such as improving their diet, exercising regularly, and monitoring their renal function. The NHIA estimates that approximately 153,000 patients with chronic renal diseases and 16,000 patients with heart failure could benefit from this new reimbursement policy.
In light of the challenges posed by an aging society, the Joint Establishment Meeting agreed to relax reimbursement regulations for osteoporosis medications by offering primary preventive treatment to patients at high risk of bone fractures. Additionally, for secondary prevention, the reimbursement scope will be broadened to include not only fractures in axial bones but also peripheral bones, such as the radius and humerus. This expansion is expected to benefit approximately 134,000 people annually, with an additional NT$865 million allocated to NHI drug fees.
Cancer treatments are to include immunotherapy drugs for metastatic small-cell lung cancer, hepatocellular carcinoma, and biliary tract cancer, as well as HER2-targeted drugs for breast cancer and targeted therapies for colorectal cancer. Dr. Shih Chung-Liang explained that the coverage for immune checkpoint inhibitors (IO) will be expanded to include drugs such as durvalumab and tremelimumab. This expansion is projected to benefit 1,938 patients annually, with an estimated additional cost of NT$1.28 billion per year.
For liver cancer, dual immune checkpoint inhibitor (IO) combination therapy will be included to align with international standards. Additionally, IO therapy is to be introduced for biliary tract cancer—a highly aggressive cancer with limited treatment options. This is expected to help extend patients' survival rates.
Anti-angiogenic agents will be available under the NHI for premature infants. Dr. Shih noted that although drug companies did not submit clinical trial results for new-borns when applying for drug licenses, and neonatal use is not included in the approved package insert, international treatment guidelines and medical associations in Taiwan have recognized the effectiveness of this treatment for retinopathy of prematurity. The Joint Establishment Meeting has therefore decided to include this indication, marking a significant breakthrough in the NHI reimbursement policy.
【2024-12-22 / Liberty Times】
