Reported by Lee Shu-Ren
The difficulties in getting NHI reimbursement have prevented patients from accessing new cancer treatments, said experts. According to a study, it takes about 420 days for a new drug to be reviewed and be included in the NHI pharmaceutical benefit scheme under the 2nd Generation of the NHI system. The waiting time is even longer for new cancer drugs, an average of 728 days. Even after being listed in the benefit scheme, it takes between 3 and 5 years for a new cancer drug to be available in hospitals due to complicated procurement and administrative procedures implemented by hospitals.
Details on the problems of applying for the NHI listing were revealed in the forum on how to increase the access to new cancer drugs. Janice Chen from the KFSYS expressed that the discovery of new cancer drugs always raises hope for many patients; however, the reality is cruel as most patients perish before the new drugs become available under the NHI.
Janice Chen pointed out that the biggest issue about NHI listing is that the procedure is too time-consuming. Even if an application has been approved by the expert meeting and the NHI joint establishment meeting, it still needs 3-5 years to be actually available for patients. High prices are another factor which further affects patient’s access to new drugs.
Shih Ru-Liang from the NHIA explained that drug companies usually file the applications of drug licenses and the NHI listing at the same time. The NHIA will forward the application to the expert meeting within 90 days of receiving the application. Once it is approved by the expert meeting, the case will be sent to the joint meeting in two months.
Shih Ru-Liang pointed out that representatives of various stakeholders have been included in the review meeting since the implementation of the 2G NHI. It has an impact on the progress of the drug review meeting as representatives of healthcare providers usually oppose the listing of new cancer drugs on grounds of financial impact.
The Global Budget system is another factor hinders the NHI reimbursement of new drugs. Janice Chen expressed that the listing of new drugs or new technology depreciates the point value under the Global Budget system, hence affects hospital’s income.
As for how to reduce the financial impact from new drug reimbursement, Janice Chen suggested that in addition to a premium hike, the government can consider excluding treatments for ailments from the NHI coverage, such as cold relief treatments which cost the NHI NT$20 billion a year.
Janice Chen expressed that the current NHI reimbursement scope covers everything from fatal illness, severe diseases and rare diseases to ailments. A reform is necessary.
Janice Chen suggested introducing the co-payment system by charging patients a certain percentage of drug fees. For example, patients in Japan and South Korea have to pay 20-30% of drug fees out of their pocket.
In reply to Chen’s suggestions, Shih Ru-Liang said that the NHIA agrees with the idea of co-payment for new cancer drugs; however, this approach is not allowed by the existing laws. The NHIA does not have the authority to ask patients to pay extra for their drugs. She suggested that patient groups can make a proposal and campaign for law amendment based on consensus formed by the society.
【2017-06-12 / United Daily】