Reported by Lo Chen and Chang Yi-Hua from Taipei

People have been wondering what prevents the NHI from reimbursing new cancer drugs.  Scholars pointed out that there are four major issues: the difficulty with the assessment of new drug effectiveness, the inadequate structure of the assessment of new drug values, the divided opinions on NHI reimbursement decisions and the limited NHI resources.  

Prof. Pu Jo-Fang of the Taipei Medical University explained that the reimbursement decision about a new drug is made by the NHI Drug Dispensing Items and Fee Schedule Joint Establishment Meeting after consulting with experts.  The assessment takes into account of the drug’s comparative efficacy, cost benefit analysis and financial impact, as well as other considerations such as ethics, laws and social values, etc.

On average, it takes about 2 years to have a listed new cancer drug on the NHI Pharmaceutical Benefit Scheme.  The NHI Global Budget system and new drug listing procedure both contribute to the long wait of new cancer drugs.

Dr Ke Bo-Sheng, a hematology oncologist of the NTUH, expressed that it is a straight forward procedure for obtaining the marketing authorization; however, a valid license does not guarantee the NHI reimbursement.  Drug licenses are issued based on the evaluation of benefits and risks.  The decision of NHI reimbursement is, however, based on the drugs’ cost effectiveness and comparative benefits.   As the regulatory authorities around the world are cutting the red tape, more and more new drugs are brought to the market but waiting in the pipeline for reimbursement assessment.

The environment in Taiwan is another issue.   Dr Ke said that the ratio of the total health spending to the GDP is still quite low in Taiwan.  The pressure on the healthcare system has limited the growth of drug spending.  As the government is reluctant to increase the premium fees, the number of new drugs available under the NHI will remain limited. 

The discussions in the NHI reimbursement meeting are usually futile because some members focus on the costs and some concern most about drug efficacy.  Dr Ke stated that the NHI reimbursement meeting should have discussed about formulating a reasonable resource allocation model by estimating the annual health spending required by the nation.  If the funding is not sufficient to meet the need, the insured will have to either compromise with the results of limited access to new drugs or face a premium hike.

Prof. Pu pointed out that, under the Global Budget system, the NHI sets an individual budget for western medicine, primary care, dentistry and Chinese medicine respectively.  The NHIA needs to consider the financial impact from new drugs on departmental budgets. 

In the UK, the National Institute for Health and Care Excellence (NICE) is responsible for assessing the scientific and social values of new drugs.  The scientific values include clinical benefits and cost benefit analysis; and the social values depend on the public’s needs and expectations.  The NICE holds public meetings regularly so as to understand the social expectation which will be taken account of in the decision-making process.

Prof. Pu praised and recommended the mechanism of including public discussion in the new drug listing procedure. 

【2018-08-22 / United Daily News】