Last year, health insurance drug costs surpassed 240 billion NTD, making drug policy reform urgent. To balance efficacy and cost-saving, the National Health Insurance Administration (NHIA) is launching a pilot program today to encourage the use of six major biosimilar drugs. Doctors who prescribe these drugs can receive additional incentive payments. The goal is to increase the replacement rate from the current 7.38% to 30% over the next three years, which is estimated to save 270 million NTD in drug costs. This will accelerate resource reallocation and allow more new drugs to benefit patients.
Aging Society and Increasing Healthcare Burden
In the past five years, health insurance drug costs have continuously increased, growing from 208.2 billion NTD in 2019 to 243.1 billion NTD last year. Next year, Taiwan will become a "super-aged society," where one in five people will be elderly, further increasing the healthcare burden.
At the final Health Taiwan Forum in late April, Vice Convener Jyh-Hong Chen, from the Health Taiwan Promotion Committee led by President Ching-Te Lai, pointed out that drug supply is a challenge for health insurance and that drug policy should be reviewed, including building consensus on biosimilar drug policies.
NHIA Deputy Director-General I-Ming Parng stated that, in response to an aging population, low birth rate, and limited medical resources, reducing the prices of high-cost drugs and encouraging the use of biosimilars are common challenges faced by many countries. As patents for original biological drugs expire, countries in Europe, the U.S., and Japan are encouraging the use of biosimilars, which have similar quality but lower development, manufacturing costs, and prices. This approach reduces drug expenses while creating opportunities to introduce more innovative drugs to treat more patients. Therefore, Taiwan is also promoting a pilot program to encourage the use of biosimilars.
Six Major Components Related to Immunomodulation
I-Ming Parng explained that to encourage healthcare institutions to use biosimilars, the pilot program includes two major measures. First, doctors who prescribe drugs containing six major components will receive an additional 150 points (approximately 0.9 NTD per point) on top of the existing consultation fee. Second, some in the medical community are concerned that the lower costs of biosimilars might reduce the total health insurance budget for each region, but any gaps will be filled to ensure no impact.
The pilot program encourages the use of biosimilars with six major components, including adalimumab and etanercept, mainly related to immunomodulation. These are primarily used to treat psoriasis, rheumatoid arthritis, ankylosing spondylitis, hematological tumors, breast cancer, and osteoporosis. Most of these biosimilars are imported and manufactured by major international companies.
According to NHIA statistics, last year, there were 11 biosimilar components and 41 items covered by health insurance, accounting for 7.38% of all drugs with the same components. I-Ming Parng indicated that the three-year pilot program aims to increase the replacement rate to 30%, potentially saving 270 million NTD in health insurance drug costs.
Resource (mandarin) : 今起試辦！醫師開生物相似藥可獲獎勵／3年替代占率目標提高至30％ 預估可節省2.7億藥費
