Beginning April 1, the national health insurance program (NHI) begun coverage of immunotherapy drugs for 800 patients at annual costs of NT$800 million. However, the latest estimate shows that as of the beginning of June, about 65 percent of the budget has already been used to provide treatments for more than 500 patients. At that pace, the immunotherapy budget could be depleted by August, which would prevent new patients from being enrolled unless some patients are willing to drop out of treatment to free up quotas.

The NHI covers immunotherapy for eight types of cancers as well as 11 indications. Between the beginning of coverage in April and June, 517 patients have been approved for enrollment and among them are 146 lung cancer patients, 138 liver cancer patients and 63 gastric cancer patients, 53 melanoma patients, 50 kidney cancer patients, 44 urothelial carcinoma patients and five head and neck cancer patients as well as five lymphoma patients.

Medical Review and Pharmaceutical Benefits Division Director Tai Hsueh-yung pointed out that the NHI’s coverage rules for immunotherapy dictate that following three months of treatments, patients would be assessed to gauge the effectiveness of their immunotherapies. In the event that the treatments are found to be ineffective or even detrimental, coverage for immunotherapy would be halted until patients’ condition stabilize. The first round of treatment review is set to take place in June.

For next year, the immunotherapy spending is still set at NT$800 million and expected to cover around the same number of patients as this year. As the number of patients covered is fixed, once the cap is reached, no additional patients may be enrolled unless some of the quotas is freed up when patients die or found to be unresponsive to treatment and dropped from enrollment.

National Health Insurance Administration (NHIA) Director-General Lee Po-chang said that as there are many patients to cover under a limited budget, the NHIA is actively negotiating with pharmaceutical companies to lower immunotherapy drug prices to expand the coverage quota.

Hope Foundation for Cancer Care Chairman and attending physician of hematology and oncology at Keelung Chang Gung Memorial Hospital Wang Cheng-hsu acknowledged that there are no clear solutions to overcoming the challenges of providing coverage for expensive immunotherapy drugs to as many patients as possible under a limited budget, and said that he is hopeful that the NHIA would be successful in drug price negotiations to help more patients.

【2019-06-09 / United Daily News】