The National Health Insurance Administration (NHIA) convened a Pharmaceutical Benefit and Reimbursement Scheme Joint Committee Meeting on December 19, 2024. Through the joint efforts of representatives from the medical and pharmaceutical fields, payers, and patient organizations, numerous new drugs have been added to NHI benefits, and various payment regulations have been loosened. These new measures will directly benefit cancer patients, children, pregnant women, and patients with chronic kidney disease, taking effect as early as February 1, 2025. The changes aim to better align the NHI program with international treatment guidelines, enhance healthcare for the public, and reduce the financial burden on patients' families.

I. New Cancer Drugs that Align with International Treatment Guidelines:

1. Medications containing durvalumab and medications containing tremelimumab:
   The NHIA is gradually introducing immunotherapy drugs to align with international treatment guidelines. These medications have been approved for inclusion in the NHI benefits to treat extensive-stage small cell lung cancer, hepatocellular carcinoma, and cholangiocarcinoma. This inclusion is expected to benefit 1,938 patients, with an estimated annual drug expenditure of NT$1.28 billion.
2. Medications containing trastuzumab deruxtecan:
   To improve survival rates and reduce mortality in metastatic breast cancer, the committee has approved the inclusion of these medications in the NHI benefits as a second-line treatment for patients with HER2-overexpressed metastatic breast cancer and patients with ER- and PR-negative, HER2-underexpressed inoperable locally advanced or metastatic breast cancer. This inclusion is estimated to benefit 1,172 patients annually. The NHI program will invest NT$1.588 billion annually in drug expenses, allowing each patient to save approximately NT$1.46 million per year.
3. Biosimilars containing bevacizumab:
   The NHI benefits already cover targeted therapy drugs for first-line, third-line, and fourth-line treatments of metastatic colorectal cancer. To bridge the gap in clinical treatments, the committee has approved the expansion of coverage to include medications containing bevacizumab for second-line treatment. This inclusion is expected to benefit 842 patients, with the NHI program investing around NT$202 million each year.

II. Meeting Clinical Needs of Children, Pregnant Women, the Elderly, and Patients with Chronic Kidney Disease:

1. Revision of Reimbursement Regulations for medications containing belimumab used to treat active lupus nephritis and systemic lupus erythematosus:
   Regulations regarding steroid dosage in the standard treatment of lupus nephritis have been loosened, and the payment package now covers treatments for lupus erythematosus in both pediatric and adult patients. This revision is expected to benefit 1,605 patients with lupus nephritis and systemic lupus erythematosus annually. With the NHI program investing NT$371 million annually in drug expenses, each patient can save approximately NT$320 thousand per year.
2. Revision of Reimbursement Regulations for Osteoporosis Treatment Drugs:
   In response to Taiwan's aging population and the significant impact of osteoporosis on public health, the reimbursement scope has been expanded to include primary prevention. This applies to patients with osteoporosis or osteopenia who have not yet experienced fractures but are at high risk. Additionally, coverage for secondary prevention has been extended to include patients with fractures of the distal radius and proximal humerus. This revision is expected to benefit approximately 134,000 osteoporosis and osteopenia patients annually, with an estimated annual drug expenditure of NT$865 million.
3. Ophthalmic Neovascular Inhibitors (Anti-VEGF) Ranibizumab, Aflibercept, and Bevacizumab:
   To improve the care of premature infants, reimbursement has been expanded to include retinopathy of prematurity, following the consensus recommendations of the Taiwan Pediatric Association and the Ophthalmological Society of Taiwan. This revision is expected to benefit 338 premature infants annually, with an estimated annual drug expenditure of approximately NT$7.5 million.
4. Tocolytic Drugs Containing Atosiban:
   To enhance maternal care, the use of atosiban has been approved for extremely preterm cases between 24 to 28 weeks of gestation. Additionally, the eligibility has been expanded to include high-risk, such as patients with diabetes (pre-gestational and gestational) and those who exhibit poor efficacy or intolerance to ritodrine. This revision is expected to benefit 3,226 pregnant women annually, with an estimated annual drug expenditure of approximately NT$40 million.
5. Medications containing dapagliflozin and medications containing empagliflozin:
   The reimbursement scope has been expanded to include patients with chronic kidney disease and those with chronic heart failure with reduced ejection fraction (LVEF 41% to 49%). This revision is expected to result in an annual drug expenditure of approximately NT$1.6 billion, benefiting an estimated 153,000 chronic kidney disease patients and 16,000 chronic heart failure patients with reduced ejection fraction each year.

The NHI prioritizes the care of women and children, the elderly, and patients with severe conditions. It is committed to providing holistic care and actively expanding medication coverage in line with international guidelines. Despite limited resources, the NHI strives to offer evidence-based and cost-effective benefits, ensuring that more patients receive necessary treatments while safeguarding the nation's health.