Partial reimbursement available for Next-Generation Sequencing (NGS)
Next-Generation Sequencing (NGS) is a test used to evaluate cancer drug efficacy or bone marrow transplantation. The Ministry of Health and Welfare's National Health Insurance Administration convened a meeting to jointly draft reimbursement items and payment standards for medical services. The reimbursement plan, which was approved at the meeting, includes fixed payments ranging from 10,000 to 30,000 points (with a floating point value of approximately NT$0.90 to NT$0.98 per point) for medical services. This represents money saved for patients. However, individuals may choose to pay the difference to expand the testing coverage based on their circumstances. It is estimated that around 20,000 people will benefit from this annually, with a budget of approximately NT$300 million, set to be implemented as early as May 1.
Fixed Payment Plan with an Annual Budget of NT$300 million
NHIA Director-General Shih Chung-liang explained that the three fixed payment plans include 10,000 points for longer segments of the BRCA1 and BRCA2 genes, 20,000 points for small kits with fewer than 100 gene loci required for various cancers, and 30,000 points for large kits with more than 100 gene loci. For example, if a patient needs to test 80 to 90 loci, which would cost around NT$50,000 to NT$60,000, they will receive NT$20,000 in reimbursement from the health insurance, with the remainder to be paid out of pocket.
Shih Chung-liang pointed out that NGS is used for the diagnosis of physical cancers, assessment of drug suitability, and prognosis evaluation. Reimbursement will be provided for fourteen cancer categories such as non-small cell lung cancer. For hematological tumors, NGS is used to assess eligibility for bone marrow transplantation, with reimbursement provided for five cancer categories such as acute myeloid leukemia. Each cancer category has its own payment standards, including testing timing, sample types (tissue or blood), and coverage of gene loci, all of which are detailed.
Payment Standards for 19 Categories
Both hospitals and testing units must be certified
Shih Chung-liang also mentioned that applications for health insurance reimbursement are applicable to hospitals certified at regional level or above or with cancer treatment quality certification. Testing units must also be certified by the Ministry of Health and Welfare. Individuals can receive reimbursement for each type of cancer only once in their lifetime and must sign an agreement to upload reports to the designated database for subsequent policy evaluations.
However, the annual expenditure budget has been reduced from the original estimate of NT$900 million to NT$300 million. Shih Chung-liang explained that this is mainly due to the acceptance of single-gene testing for certain cancer categories such as lung cancer, resulting in reduced costs.
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