The National Health Insurance Administration (NHIA) approved the payment coverage for multiple new drugs to enhance care for vulnerable groups such as patients with rare diseases, children, and patients with Crohn's disease. The NHIA is estimated to put in over NT$2.395 billion for drug expenses, benefitting around 2,352 patients.
The NHIA has always prioritized children's healthcare and the quality of their treatments. Neonatal respiratory distress syndrome, common among preterm newborns, often causes shortness of breath, cyanosis, and even death. To effectively mitigate the symptoms and ease the discomfort of intubation for neonatal patients, the NHIA expedited the inclusion of a new drug, Curosurf, in the payment package and loosened relevant restrictions for neonatal patients who did not receive intubation. This inclusion aims to ensure early medication and reduce neonatal mortality rate.
To meet the expectations of patients with spinal muscular atrophy (SMA), the payment restrictions for spinal injections containing nusinersen and oral medications containing risdiplam have been loosened: (1) Coverage now extends to patients diagnosed with SMA before "the age of 18", up from the age of 3; (2) RULM score of 15 or above for initiation is removed; and (3) Allowing one switch to another medication if severe intolerance occurs with nusinersen or risdiplam. For this coverage modification, pharmaceutical companies have agreed to lower the price of relevant drugs, bring yearly drug expense for each patient to around NT$6.6 million. These measures benefit about 250 patients with the NHIA investing an additional NT$1.9 billion in drug expenses.
Clinically, targeted therapy drugs for IL-36 mutation-related generalized pustular psoriasis are not currently available. Considering that new drugs containing spesolimab have not yet been recommended by any of the three major health technology assessment organizations, the NHIA included these drugs in the payment package by means of conditional listing in July 2024, allowing patients to receive treatments with these new drugs. At the same time, the NHIA will conduct a two-year real-world data collection on the number of acute onsets and the frequency of hospitalization of patients after receiving treatments with the new drug. If the data prove the new drug is cost-effective, the drug will be included in the standard payment package.
A new IgGl-human monoclinal antibody drug for Crohn's disease, Risankizumab, is now included in the payment package as an additional option for doctors to prescribe. According to the data provided by Taiwan Society of Inflammatory Bowel Disease, without adequate control, Crohn's disease and ulcerative colitis may cause long-term complications of abnormal epithelial hyperplasia and colon cancer, potentially leading to death in severe cases. Therefore, the NHIA has loosened the payment restrictions for Crohn's disease and ulcerative colitis drugs. Patients who experience relapse after stopping the medication when a treatment course ends twice in a row with the second relapse occurring within three months of the medication ceasing to be effective, may now continue their medication. In addition, the NHI payment package now covers drugs containing abrocitinib for patients aged 12 to 18 years with moderate to severe atopic dermatitis.
To improve the accessibility of new drugs, the NHIA strives to speed up the inclusion of new drugs and expand the payment coverage. In the future, the NHIA shall continue to collaborate with representatives in the Pharmaceutical Benefit and Reimbursement Scheme Joint Committee Meeting (including experts, medical groups, representatives from premium payers, patient groups, and pharmaceutical representatives) to offer cost-effective new drugs in the payment package.