(By Chieh-Ling Chen, Central News Agency, Taipei, March 7) The National Health Insurance Administration (NHIA) has decided to expand coverage for Spinal Muscular Atrophy (SMA) treatments. On March 7, an expert meeting resolved to remove payment restrictions and eliminate the reliance on patients' motor functions as a criterion for NHI coverage eligibility. This decision will make all (approximately 400) SMA patients in Taiwan eligible for such treatments covered by the NHI, with new regulations set to take effect possibly as soon as May, backed by an allocation of NT$3.8 billion from the Global Budget.

Currently, treatments for SMA, such as Spinraza injections, gene therapy, and oral medications, face stringent NHI payment conditions. These include requirements like loss of motor functions, ineffectiveness of current medication, and a Revised Upper Limb Module score of 15 or above, making only about 100 patients eligible for NHI-covered treatment under these conditions. However, roughly 250 patients remain ineligible.

Given the high cost of SMA treatments, the NHI has been gradually including various treatments in its coverage scheme. Yet, some patients are still ineligible for NHI-covered treatments. Acknowledging this, experts have advocated for the relaxation of payment restrictions concerning patients' age and motor functions. Pharmaceutical companies have requested that the NHIA extend NHI payments to all SMA patients, prompting the NHIA to hold the expert meeting to discuss this issue on March 7.

Director General Chung-Liang Shih of the NHIA remarked that the experts concurred on the lack of a direct correlation between motor functions and treatment effectiveness. Consequently, they agreed to relax payment restrictions and will exclude motor function evaluation results from the payment criteria. Nonetheless, due to the high costs of these treatments, a threshold for discontinuation will be set; if a patient's condition continues to worsen despite treatment, indicating ineffectiveness, NHI payments will cease.

Director General Shih also mentioned that the criteria for discontinuation and payment standards would be announced together. With the eased restrictions on Spinraza injections and oral medications, the NHI is set to cover over NT$7 million in medication costs per patient annually, benefiting more than 250 additional patients. Thus, all 400 SMA patients in Taiwan will now be eligible for NHI coverage for these treatments. Detailed discussions will continue in the Pharmaceutical Benefit and Reimbursement Scheme Joint Committee Meeting, with the new policies expected to be implemented as early as May or June.