Conditional Inclusion of Oral Drug Treatment for Hepatitis C in the National Health Insurance Coverage as of January 24, 2017Date：2017-02-24
Inclusion of oral drug treatment for hepatitis C in the National Health Insurance (NHI) coverage is one of the key public health policies advocated by President Tsai Ing-wen. After this drug was conditionally included in the NHI coverage by the NHI Supervisory Board of the Ministry of Health and Welfare in December 2016, the NHI Administration (NHIA) announced that as of today (18th), gastroenterologists of all medical institutions are permitted to screen for patients who meet the inclusion criteria by registering on the VPN system. This drug is made accessible to patients as of the 24th of this month to bring forth significant benefits to the first batch of hepatitis C patients before the Chinese New Year.
The NHIA reported that in the total budget allocation for NHI in 2017, a total of NT$3.101 billion (NT$2.655 billion to hospitals and NT$446 million to primary care services) is allocated specifically for hepatitis C medication, of which NT$2 billion will be used to cover the oral drug treatment (NT$1.712 billion to hospitals and NT$288 million to primary care services). The remaining NT$1.001 billion will be reserved for patients that do not meet the usage criteria and still require traditional interferon treatments.
The NHIA further indicated that due to limited budget, the oral drug treatment for hepatitis C will be made available at the first stage to patients with type I chronic hepatitis C and to patients with F3 and above (inclusive) fibrosis that have experienced failed interferon plus ribavirin therapy. If there is a remaining budget after use by patients that meet the first-stage criteria, the NHIA will discuss making the treatment available to patients who meet the second-stage criteria.
To care for all hepatitis C patients across Taiwan, the NHIA will allocate in advance the number of patients allowable for each hospital and clinic according to a distribution approach, in which the first half of the year is divided into three stages and branch regions. The distribution approach is based on the number of cases that were registered (in an on-going project for hepatitis B and C treatment) as having used NHI coverage for hepatitis C treatment to distribute a budget of NT$2 billion. Given that one session costs approximately NT$250,000 per person, there is a quota of 8,000 patients, of which 6,848 is distributed to hospitals and 1,152 to clinics. After six months, the budget will be readjusted if there is a balance.
It is worth mentioning that because the oral drug treatment for hepatitis C is extremely expensive, the NHIA will adopt an individual case registration system to conduct management and control in order to prevent waste of resources resulting from failure to take drug on time. In other words, patients must seek medical attention at a medical institution and be evaluated by a physician as fulfilling the inclusion criteria. The medical institution will then record the patient’s disease condition on the individual case registration system, submit the patient’s information, confirm that the budget requirement is met, and obtain a case number to begin prescribing the drug that is covered by the NHI.
The NHIA further stated that to facilitate the preparation work of medical institutions, the individual case registration system will be open for access starting today (18th) to record and temporarily store the information of eligible patients that meet the coverage criteria. The queuing operation will commence as of the effective payment date on January 24, 2017.
To prevent abuse of patient access to the drug, the NHIA emphasized that doctors must register the date on which the patient started using the oral drug treatment and ensure that the drug is prescribed on the date of prescription for patient use. In addition, to ensure information transparency and mitigate disputes, the NHIA will announce daily on its website the quota in each region and the number of patients using the oral drug treatment.
From: National Health Insurance Administration Ministry of Health and Welfare