Reported by Liu Chia-Yun from Taipei

Cancers account for about 170,000 deaths in Taiwan every year.  The NHI spends over NT$20 billion on cancer drugs annually.  However, some new generation treatment methods, such as targeted therapies and immunotherapies, are not yet included in the NHI Benefit Scheme because of their high treatment costs.  New drugs not reimbursed by the NHI are, on the whole, not financially accessible for patients.

Doctors and patient groups urge the NHI to listen to patients’ needs and to include new cancer drugs into the NHI Benefit Scheme.  Dr Lee Po-Chang, General Director of the NHIA, stresses that the NHIA has set NT$2.5 billion as a ring-fenced annual budget for new cancer drugs.  However, the NHIA is still contemplating whether the reimbursement decision should be made based on the severity of a cancer or by the size of patient population.

According to the NHIA’s data, the NHI spending on cancer drugs increased from NT$2 billion in 2000 to NT$20.5 billion in 2016.  Though the NHI budget was up by 35.5% from 1998 to 2017, the NHI is still struggling to meet every patient’s need.  In fact, an increase in the spending on cancer drugs implies a decrease in the payment for other drugs.

The NHIA is studying the possibility of implementing the Managed Entry Agreement (MEA) and has reached preliminary consensus.  According to Dr Lee Po-Chang, with the MEA, manufacturers will have to guarantee the effectiveness of their drugs, for example, a higher survival rate.  The NHI is expecting positive results from its spending on new drugs.

How can drug effectiveness be justified?  Dr Lee explains that drug manufacturers will be requested to provide the median overall survival of patients using their new drug; and the NHI will only pay for cases who outlive the median survival.  Otherwise, the NHI will either refuse to reimburse for the treatment or reimburse at a discount.

Dr Lee states that the NHIA has received more than 20 NHI listing applications of new cancer drugs.  Therefore, it is not yet clear which drugs will be included in the NHI Benefit Scheme this year.  However, a budget of NT$2.5 billion has been ring-fences for new cancer drugs.  As the budget is limited, Dr Lee urges doctors to use the resources carefully and reasonably.

Dr Lee stresses that medication is the result of disease treatment; hence, what’s more important is the establishment of standard treatment guidelines for each cancer respectively so that patients can have a protocol to follow, instead of trying different treatments and wasting healthcare resources.

In order to control drug spending, Dr Lee expresses that the NHIA is promoting the Cloud-based patients’ record system, which warns doctors of duplicate prescriptions.  As for patients, the NHIA is imposing the drug co-payment to prompt patients to cherish the healthcare resources.

【2018-04-25/ United Daily News】