As Taiwan transitions into a super-aged demographic profile, the National Health Insurance (NHI) global budget has crossed the critical threshold of NT$1 trillion, demonstrating an annualized growth rate of 5.5% to reach an all-time financial peak. Concurrently, the newly allocated budget for New Medical Technologies has settled at NT$7.858 billion, a growth vector that clinical leaders and patient advocacy groups argue lags behind the rapid pace of biopharma innovation. Policy experts are urging the government to implement structured, rule-based budgetary escalations rather than relying on arbitrary ad-hoc negotiations, pointing to advanced global economic models to balance fiscal sustainability with rapid patient access to novel therapeutics.

The Cost Trajectory of Next-Generation Biologics

Dr. Yu Chung-jen, President of National Taiwan University Hospital (NTUH), and Dr. Shen Yen-shen, Distinguished Professor at National Cheng Kung University (NCKU)—both serving as key members of the Presidential Office's Healthy Taiwan Advisory Committee—observed that the technological evolution from traditional small-molecule chemical formulations to complex biologics, antibody-drug conjugates (ADCs), cell therapies, and genetic medicines has dramatically escalated clinical development costs. While acknowledging that these next-generation therapeutics command premium prices, both experts emphasized their superior clinical efficacy and stressed that the state must build a resilient, long-term fiscal architecture to absorb them.

Resolving the Drug Pricing Disparity and Market Flight

Currently, a disproportionate 60% of the NHI pharmaceutical budget is consumed by off-patent, mature multi-source medicines, leaving only 40% to fund innovative, patent-protected drugs. Furthermore, the rigid enforcement of the Drug Expenditure Target (DET) system and its subsequent price-cutting mandates have caused numerous international pharmaceutical companies to withdraw critical original therapies from the Taiwanese market.

To mitigate this, Dr. Yu Chung-jen formally proposed to the Healthy Taiwan Advisory Committee a temporary suspension and comprehensive reform of the current price investigation mechanisms. His policy blueprint aims to protect single-source, critical original medicines from unsustainable price deprecation while aggressively increasing the utilization rate of lower-cost local generics to shrink expenditures on mature, off-patent drug segments.

Regional Disparities and Healthcare Equity Challenges

Using oncology as a baseline, Dr. Shen Yen-shen pointed out that despite the government's establishment of the NT$10 billion Taiwan Cancer New Drug Multi-Support Fund (TCNDF), an average 1.5-year regulatory gap persists between Taiwan FDA (TFDA) approval and actual NHI reimbursement listing. During this window, patients are forced to pay entirely out-of-pocket for life-saving care.

This regulatory lag has created severe regional health disparities. Patients located in wealthier northern urban zones routinely access novel therapeutics via private capital, whereas rural agricultural workers and low-income demographics across southern regions frequently decline treatment due to financial constraints. Dr. Shen recounted clinical experiences where low-income patients preferred to halt therapy altogether rather than take private loans, realizing they could not sustain the recurring NT$300,000 monthly out-of-pocket expense for modern cancer regimens. This financial barrier presents a direct challenge to the nation's goal of healthcare equity.

Copayment Reform and Global Benchmarking

To guarantee patient access while preventing systemic financial imbalance, Dr. Yu suggested adopting a reference-pricing copayment system (藥品差額給付制度), similar to models long established in Japan and South Korea and currently utilized for specialized medical devices within Taiwan's NHI framework. Under this model, the NHI covers the baseline drug cost, and the patient pays the differential balance for premium therapies. This mechanism would support the long-term sustainability of the fund, curb medical waste caused by non-compliance, and increase personal health-management awareness, provided that robust safety nets are built to insulate vulnerable socio-economic demographics.

Regarding budget formulation, Dr. Jasmine Pua (蒲若芳), Executive Director of the Data Science Center at the Fu Jen Catholic University College of Medicine, recommended that Taiwan benchmark its methodologies against advanced nations. She highlighted the UK National Health Service (NHS) health technology assessment (HTA) framework and Australia’s institutional practice of publishing rolling, long-term actuarial financial forecasts. Incorporating forward-looking data on upcoming patent expirations and incoming drug pipelines would allow the legislature and healthcare stakeholders to anticipate budgetary requirements scientifically.

Furthermore, Liu Huan-jui, Secretary-General of the Taiwan Young Patient Association (TYPA), emphasized that current budget calculations lack transparency and predictability. He urged the implementation of open, standardized indicators to formalize the budgeting process, ensuring it aligns with evolving international clinical treatment guidelines.

Resource:健保永續 預算提升制度化 因應新藥需求