The NHIA announced a new reimbursement policy, effective October 1, to expand coverage for four cancer drugs, two orphan drugs, and one drug for cardiovascular disease. Before the implementation of this policy, treatment options for esophageal cancer and head and neck cancer were quite limited. Under the new policy, patients will have access to additional treatment options, including immune checkpoint inhibitors. The NHIA will also cover a one-time treatment with CAR-T cell therapy for adult patients with certain types of diffuse large B-cell lymphoma and high-grade B-cell lymphoma. The cost of this CAR-T cell therapy is approximately NT$8.19 million.
One of the four cancer drugs covered under the new policy contains tislelizumab, an immunotherapy used to treat esophageal squamous cell carcinoma. This drug is among the treatment options recommended by the National Comprehensive Cancer Network (NCCN) and may also be used to treat other types of cancer.
Another drug covered under this policy is pembrolizumab, which is used as a first-line treatment for metastatic or unresectable recurrent head and neck squamous cell carcinoma (HNSCC). Pembrolizumab is also recommended by the NCCN for the treatment of head and neck cancer. The NHIA is committed to aligning its treatment guidelines with international clinical practices.
Two other cancer treatments covered under the expanded reimbursement policy are mogamulizumab and axicabtagene ciloleucel, a CAR-T cell therapy. Mogamulizumab is indicated for adult patients with mycosis fungoides or Sézary syndrome who require systemic therapy. Patients with either CD30-positive or CD30-negative disease may be eligible for this treatment.
Axicabtagene ciloleucel is a CAR-T cell therapy used to treat adult patients with certain types of diffuse large B-cell lymphoma and high-grade B-cell lymphoma.
The expanded reimbursement coverage for cancer drugs is expected to benefit approximately 2,600 patients and cost the National Health Insurance (NHI) system about NT$1.976 billion.
For rare diseases, the NHI continues to address patients’ needs by expanding access to new treatment options. The new policy adds pegcetacoplan as a treatment option for patients with paroxysmal nocturnal hemoglobinuria (PNH). It is indicated for patients who continue to experience suboptimal treatment responses, such as inadequate control of hemolysis, despite receiving existing C5 complement inhibitor therapy.
In addition, the minimum age for eligibility for NHI-reimbursed oral medication for Fabry disease has been lowered from 16 to 12 years. This change provides younger patients with access to a more convenient treatment option.
The NHIA noted that this new policy also relaxes the reimbursement criteria for the drug containing rivaroxaban and refines the criteria regarding the frequency of cardiovascular events and peripheral artery stenosis for benefit eligibility, so as to allow patients with clinical needs to access appropriate treatment more quickly. The NHIA estimated that over 12,000 patients could benefit from this policy, with total drug costs of NT$590 million.
The Director-General of the NHIA, Dr. Chen Liang-Yu, expressed that as cancer treatment progresses at a rapid pace, the NHI is proactively working to bring treatment options into line with international guidelines and practices. The NHIA will continue to carefully evaluate the benefits of new treatments and strive to provide more appropriate treatment options for patients, with a view to reducing patients’ financial burden.
【2026-10-02 / United Daily】
