The National Health Insurance Administration (NHIA) implemented several new pharmaceutical reimbursement measures on September 1, 2026. These measures include amending reimbursement regulations for hypolipidemic agents to align with clinical consensus and adding coverage for treatments for rare diseases such as paroxysmal nocturnal hemoglobinuria (PNH) and cholestatic pruritus.
Director General Lian-Yu Chen stated that the NHIA continues to introduce new medications with demonstrated clinical benefits based on the latest scientific evidence and international treatment guidelines. Through these efforts, the NHIA aims to improve healthcare accessibility and quality while advancing the Healthy Taiwan vision.
To achieve the "888 Program for Chronic Disease Management," the NHIA has established LDL-C treatment thresholds and targets based on atherosclerotic cardiovascular disease (ASCVD) risk levels, as outlined in the "2025 Consensus on the Clinical Pathway of Blood Cholesterol Management in Taiwan," jointly developed by nine major medical associations. In addition, the NHIA has expanded reimbursement criteria for statins, ezetimibe, and combination drugs containing ezetimibe or statins, thereby aligning Taiwan's lipid management standards with the latest clinical guidelines. These measures help patients with hyperlipidemia receive timely and appropriate medication, thereby effectively reducing the risk of cardiovascular disease and supporting comprehensive care. Approximately 1.05 million patients will benefit from this expansion, with an estimated pharmaceutical expenditure of NT$2.28 billion.
For rare disease treatment, the NHIA has included medications containing iptacopan for adult patients with paroxysmal nocturnal hemoglobinuria (PNH). The oral dosage form offers greater convenience in clinical use and provides an additional treatment option, thereby improving treatment accessibility and enhancing healthcare quality. The NHIA has allocated around NT$183 million for the medication.
To improve the quality of life for patients with rare cholestatic diseases, the NHIA has added coverage for drugs containing maralixibat chloride. These medications are indicated for the treatment of cholestatic pruritus in patients aged one year and older with Alagille syndrome (ALGS) or progressive familial intrahepatic cholestasis (PFIC). Cholestatic pruritus often leads patients to repeatedly scratch affected areas, resulting in skin abrasions, bleeding, infection, and even sepsis. This medication lowers serum bile acid levels and reduces bile acid accumulation, effectively alleviating difficult-to-manage pruritus and improving patients' quality of life. The NHIA has allocated around NT$85 million for the medication.
Director General Chen emphasized that these reimbursement measures balance clinical needs, health technology assessment, and the financial sustainability of the NHI program. Looking ahead, the NHIA will continue to introduce new drugs and innovative therapies with clinical value, and refine its pharmaceutical reimbursement scheme to improve public health and the quality of healthcare.