Pharmaceutical News
Shall NHI start the drug co-payment mechanism?

Janice Chen/ President of the Taiwan Drug Relief Foundation

During the period from the introduction of the 2nd Generation NHI system in 2013 to the end of November 2018, the NHIA received a total of 49 applications of NCE cancer drugs for NHI payment prices.  However, only 24 applications were successful.  The pass rate was just 49%. 

From the submission of an application to the effective date of the NHI drug payment price, it takes about 684 days (the median is 556 days).  Adding up the NDA process, patients usually have to wait 3 to 5 years for the access to new cancer drugs.

Moreover, in the initial stage, the NHIA usually sets priorities for reimbursement and restricts the drug access on the grounds of cost containment.  As clinical experiences accumulated, use volume expanded and drug prices reduced, there might be a petition for expanding the reimbursement scope of new drugs.

The NHIA received 39 applications for expanding the reimbursement scope of NCE cancer drugs during the period from 2013 to November 2018.  As of now, only 24 applications have passed the assessment.  The review process takes about 565 days (median 412 days).

Financial impact is the main reason behind the long wait.  This issue presents a huge challenge for the experts and representatives in charge of the review.  It also affects the price and volume negotiation between the NHIA and drug suppliers.

By focusing on clinical expertise, resource allocation and financial control, the NHIA hopes to provide high quality care for patients under a sustainable NHI system.

In Taiwan, cancers have been the number one cause of death for 35 years in a row.  There are about 100 thousand new cases and 50 thousand mortality cases every year.

Drug developers are working hard on new cancer treatments.  About 20% of the new drugs on the market every year are for cancers. The R&D criteria and standards are getting higher; however, the rate of obtaining the market authorization is comparatively low.   The R&D costs and risks push up the prices of new drugs, making them unaffordable for most patients.

If the NHI system in Taiwan still insists on following the practice of providing the reimbursement for every illness with a ceiling drug fees at NT$200, we can expect that new cancer drugs will beyond the reach of NHI patients even though they are safer and more effective.   

The NHIA should now consider introducing the drug co-payment mechanism.  For example, patients in Japan and South Korea are asked to pay 20~30% of drug fees out of their pockets.  In fact, many cancer patient groups have already petitioned to the NHIA for drug co-payment with a view to speeding up the reimbursement of new cancer treatments. 

【2018-12-27 / United Daily News】