The National Health Insurance Administration (NHIA) convened a Pharmaceutical Benefit and Reimbursement Scheme Joint Committee Meeting on October 19, 2023. This collaborative effort involved representatives from the medical and pharmaceutical fields, payers, and multiple patients' organizations. The result of this concerted endeavor has been the inclusion of numerous new drugs into the National Health Insurance (NHI) package, and various payment regulations have been loosened. Noteworthy additions to the NHI package include new cancer medications, specifically those tailored for head and neck cancers, orphan drugs designed for β-thalassaemia, and loosened payment regulations of asthma and atopic dermatitis treatments for children and chronic progressive fibrosing interstitial lung disease (PF-ILD) treatments.
The NHIA has always put a great importance on the health of children. Considering the pressing need of asthma treatments for children and the quality of life for children with atopic dermatitis, relevant payment regulations have been amended in the above-mentioned meeting. These revisions include the utilization of medications containing dupilumab for treating patients aged 12 and above with asthma, as well as patients with atopic dermatitis between 6 to 12 years of age. The annual medication expense per person is about NT$300,000 to NT$420,000. The amendment is expected to benefit approximately 1,280 patients.
To improve the accessibility of cancer medications, amendments were made in the meeting to the payment regulations regarding 5 cancer drugs and additions were made to include one new drug into the healthcare package. The new measures are as follows: (1) Medications containing pembrolizumab are now endorsed for the treatment of patients with head and neck cancers and squamous cell lung cancer. For patients with head and neck cancers, such medications are more effective than the current standard treatment with overall survival prolonged by approximately 4.1 months and the duration of response prolonged by approximately 19.2 months. For patients with squamous cell lung cancer, taking these medications prolongs the overall survival by about 5.6 months, compared to the outcomes observed with chemotherapy. (2) Medications containing atezolizumab are now approved for the treatment of patients diagnosed with small cell lung cancer; small cell lung cancer is a highly invasive cancer with grim prognosis and the only available treatment at the moment is chemotherapy. The use of such medications prolongs the overall survival by about 2 months and reduces the mortality risk by 30%. Therefore, these medications have been listed as the recommended treatment in international guidelines. (3) Medications containing palbociclib and rebociclib are now indicated for the treatment of patients in perimenopause or menopause with metastatic breast cancer. This treatment is more effective than the current standard treatment prolonging the overall survival; the amendment also expands the range of medication options to patients. (4) Medications containing larotrectinib are now indicated for the treatment of solid tumors with NTRK gene fusion. (5) Medications containing blinatumomab are now approved for the treatment of acute lymphoblastic leukemia and the addition of new medications containing zanubrutinib that can be used to treat mantle cell lymphoma and Waldenstrom's macroglobulinemia. It is estimated to benefit around 2,090 patients with the above-mentioned amendments, approximately NT$2.05 billion are invested for the medication expenses. This result in a financial impact of approximately NT$1.275 billion.
In addition to patients with cancer, the NHIA is equally concerned with the accessibility of new drugs for patients with various diseases. To take care of patients with rare diseases, a new measure of including medications containing luspatercept to treat β-thalassaemia was passed in the meeting. Presently, the only available treatment for patients with β-thalassaemia involves lifelong regular blood transfusions and iron chelators, there is no alternative treatments. This new medication significantly reduces the impacts of blood transfusion on patients. The annual medication expense per person is approximately NT$1.09 million and the addition of new medications is expected to benefit about 299 patients.
Chronic PF-ILD affects the functions of patients' lung and causes dyspnea. Moreover, there is no medications for effective treatments so far. To ensure the quality of life for the patients, amendments were made in the meeting to extend the use of medications containing nintedanib for patients with chronic PF-ILD, because the medication significantly reduces the deterioration of lung functions. The annual medication expense per person is approximately NT$64 thousand and around 1,300 patients are expected to benefit from the new measures.
The NHIA said that the resolutions of the meeting benefit various groups including children, patients with cancer, and patients with rare diseases. The objective of the meeting is to maximize benefits with limited resources through optimal distribution. The NHIA shall continuously dedicate to working with all the representatives in the Pharmaceutical Benefit and Reimbursement Scheme Joint Committee (including the experts, medical organizations, representatives of the payers, patients' organizations, and representatives of the pharmaceutical industry) to include more patients and maximize the benefits of the reimbursement scheme.