With drug balance billing once again drawing public attention, Minister of Health and Welfare Shih Chung-liang has expressed concern that the change could hinder the development of the generic drug industry. In response, former Bureau of National Health Insurance General Manager Chang Hong-jen has called for urged for comprehensive legislation, while industry experts including Taiwan Society of Regulatory Affairs for Medical Products President Kang Jaw-jou and National Advisor to the President Huang Chin-shun argued that balance billing could benefit the industry, government, and the public. 

The Taiwan Pharmaceutical Marketing & Management Association recommended the following:

• Enhance messaging to prevent the misunderstandings that balance billing could lead to class stratification in healthcare access.
• Hospitals should provide at least one drug option that does not require balance billing.
• Enhance transparency to ensure equal access to information between physicians and patients.
• Implement pilot programs and conduct ongoing reviews.

The core of the balance billing policy should not be to differentiate between originator and generic drugs, but to enable value-based brand choices, with domestically branded generics also eligible for inclusion. International experience demonstrates that patients are capable of making informed decisions based on therapeutic efficacy and affordability. Introducing market mechanisms can encourage shared decision-making between physicians and patients and foster brand competition, thereby enhancing healthcare accessibility, patient choice, and the long-term sustainability of the National Health Insurance (NHI).

However, the current “three-sameness” policy for NHI-covered drug prescriptions, combined with intense price competition, has resulted in low profitability for generic drug manufacturers, thereby weakening supply chain resilience. Going forward, greater efforts should be made to promote exports and brand development to enhance the competitiveness of domestic pharmaceutical producers. Overall, implementing balance billing in parallel with the internationalization of generic drugs can help strengthen Taiwan’s pharmaceutical industry and support its long-term sustainable development.