OBJECTIVES

Taiwan’s healthcare system is internationally regarded for its National Health Insurance (NHI) program, which provides universal, easily accessible and affordable healthcare with overall 99.9% coverage (23.6m people). The relative low spend reflects tight-control expenditure. We evaluated the budget and reimbursement policy of innovated new drugs for recent 5 years (2013-2017).

METHODS

All data were collected from the meeting notes of Expert Advisory Meeting, the PBRS committee; and the new drug HTA reports released on the NHI Administration Web site. We used descriptive statistics to analyze the trend of the prescription volume and drug expenditure about new drugs from the of NHI claims data.

RESULTS

The total new drug budget of each year is decided by the Ministry of Health and Welfare according to the average spending of new drug in the previous 5 years with an assumption of treatment substitution effect, new drug replace the current treatment within 5 years since it covered by NHI and no more budget thereafter. Each new drug will be classified as one of the three categories (I, 2A, 2B) by their therapeutic value compare to the current best comparator. A 5-years-budget-scheme is estimated refer to these three categories. In our results, there were 189 new drugs (18 in category 1, 61 in category 2A, 110 in category 2B) getting covered by NHI which spending USD$1.96 billions in the past 5 years, but only with 175 millions budget.

CONCLUSIONS

Obviously, the budget allocation for new drug is seriously insufficient. The shortage of spending was compensated by healthcare providers. Aging population and growth in chronic disease, associated with rising costs of new health technologies, putting further strain on the healthcare system's resources. A reformation should be advocated for new drug budget and reimbursement policy, since it has been implemented for 10 years.