Pharmaceutical News
NHI proposals suggesting reimbursing new cancer drugs according to patient’s survival period

Reported by Lee Shu-Jen from Taipei

The NHIA invited drug companies to attend the first negotiation meeting on cancer drug reimbursement policies.  The NHIA proposes three major directions for the reimbursement of new cancer drugs.  The NHIA suggests that in situations where the survival period of a patient receiving a new drug is shorter than the prediction, no reimbursement will be made for the new drug; however, if the new drug is superior to existing treatments but the patient’s survival period is still not as good as the prediction, then the NHI will only reimburse 10% of the drug fees.

The NHIA has been delaying the decisions of including new cancer drugs into the NHI benefit scheme because of their high costs.  The European Chamber of Commerce Taiwan (ECCT) and patient groups are very concerned about the delay and have made many appeals to the Minister of the MOHW.  Hence, the NHIA formulated three major directions and put them forward to the industry.

Dr Lee Po-Chang, the Director-General of the NHIA, said in a telephone interview that the NHI’s annual budget is NT$600 billion which is quite sufficient.  The problem is that too many resources have been wasted, for example, it is rather unreasonable that the NHI spends more on outpatient treatments than on in-hospital treatments.  New cancer drugs are just too expensive to be covered by the NHI, said Dr Lee. 

Dr Lee pointed out that the NHIA formulated three directions for negotiation with a view to keeping a balance between the interests of drug companies and the interests of patients.  One of the proposals suggests that if a patient’s survival period is shorter than the maximum of the medians of the control group’s overall survival period in clinical trials on existing treatments, the drug company must return all claimed drug fees; and if a patient’s survival period is longer than the maximum of the medians of the control group’s overall survival period in clinical trials on existing treatments but still shorter than the median of the new drug, then the drug company has to return 90% of the claimed drug fees to the NHI.

Dr Lee said that it would be odd for the NHI to pay a huge amount to drug companies if new drugs do not contribute to a better or longer life for patients in comparison with the existing drugs.  For example, if the existing treatments have an average survival of 1.5 years and the new drug has 2 years, then the NHI will not reimburse the new drug company for any case whose survival period is shorter than 1.5 years, and will only reimburse the new drug company 10% of the drug fees for cases surviving for 1.5-2 years.

International drug companies are not happy about the proposals and consider them unreasonable.   They said that it would not be fair for drug companies to cover the cost if a patient dies in an accident.  In reply, Dr Lee said there is room for discussions concerning such events.

Ms Janice Chen, the Chairperson of the Joint Meeting for PBRS, also considers the three directions are too strict and actually in conflict with each other.  The NHIA should give drug companies some room for price adjustment and negotiation; otherwise, it will not be possible for new drugs to enter the NHI system.  At the end of the day, patients will be the ultimate victims, said Ms Chen.

【2017-08-31/ United Evening News】