Since the NHIA included new cancer immunotherapy products into the NHI Benefit Scheme last April, over 1500 patients have accessed the treatments. The NHIA recently announced to expand the reimbursement scope. Patients respond well to the treatments (PR/CR) can continue receiving the treatments for another year; and patients with stable results (SD) are eligible for another 12 weeks of treatments.
Tsai Shu-Ling, Vice Director General of the NHIA, expressed that the original reimbursement regulations provide eligible patients with one year treatments of immunotherapy products, which can be extended for another 4 weeks if patients’ conditions are stable. The NHI Joint Meeting made a decision recently to expand the reimbursement scope.
According to experts’ analysis of the clinical effect of cancer immunotherapies in Taiwan, the overall response rate, based on the data of 8 cancers and 11 indications, was 24% for PR/CR and 6% for SD. About 70% of the treatments were ineffective. Treatments for stomach cancer and hepatocellular carcinoma had the lowest response rates, under 10% and 20% respectively.
Regarding ineffective treatments for stomach cancer and hepatocellular carcinoma, the NHIA is negotiating with drug companies about the refund of drug fees. Tsai Shu-Ling expressed that, considering the financial risk faced by the NHI, drug companies should share some drug fees. If 90% of the treatments are ineffective, the bill should not be footed solely by the NHI.
Tsai Li-Juan, Vice President of the Formosa Cancer Foundation, expressed that the concept of “pay for performance” had been mentioned by Dr Lee Po-Chang, the Director General of the NHIA. “Pay for Performance” will ensure the effective use of the NHI resources.
Under the “Pay for Performance” concept, patients will be assessed after 3-4 treatment courses. If the results are not satisfactory, the drug company will pick up the bill. The NHI will pay for the case only if the treatment results prove to be effective. By selecting patients, it helps to cut the NHI expenses.
Tsai Li-Juan also pleaded for patients with advanced non-small cell lung cancer and requested the NHIA to relax the current reimbursement criteria of PD-L1 expression over 50%. This petition is based on the clinical fact that some patients with lower PD-L1 expression also respond well to the treatments.
According to Tsai Shu-Ling, there was a lively debate about this issue in the expert meeting. However, due to the lack of sufficient clinical evidence in Taiwan, the experts suggested monitoring the situation for another year.
【2020-03-03 / United Daily News】
