05 Jul Drug Reimbursement and Pricing Policy in Taiwan
Healthcare need already outstrips offer in Asia–Pacific and the gap will grow with continued increases in income, population, disease burdens, and general awareness of health issues.
Taiwan has been implementing a compulsory, universal, single payer national health insurance (NHI) system since 1995, with the overall coverage reaching 99.9%. Recommendations of the Drug Benefit Committee (DBC) were unilaterally made by the governing agency, National Health Insurance Administration NHIA.
In 2013, the Pharmaceutical Benefit and Reimbursement Scheme (PBRS) Joint Committee was established with the purpose of encouraging participation of different stakeholders (government officials, health professionals, manufacturers and members of the public) in the new drug evaluation process. The PBRS Joint Committee acts as final arbiter of a new drug’s suitability to the national health insurance system.
From 2011 to 2017, 95 HTA reports were released.
28 applications (30%) conducted an HTA with a local pharmacoeconomic study, and they all received reimbursement approval. For the remaining 67 applications (70%), for which HTA was conducted without a local pharmacoeconomic analysis, 54 cases (81%) were reimbursed.
Taiwan’s decision to reimburse a new drug respects a double-tiered evaluation system and requires the assessment and approval of the DBC, also known as Expert Advisory Meeting (EAM), and the PBRS Joint Committee.
The EAM is responsible for evaluating applications of new drugs on their listing status, reimbursement prices, and benefit coverage whereas the PBRS Joint Committee is the final decision maker. In principle, four key issues are prioritised: safety, comparative effectiveness, cost effectiveness, and budget impact.
Integration of HTA into the decision-making process of drug reimbursement, listing of new drugs into the reimbursement scheme has evolved to become more open and transparent and greatly enhances the quality of decision made by the National Health Insurance Administration.