Think You Know Taiwan?

by Questa Lin | Oct 30, 2018

While nations around the world struggle to find the right balance between managing rising healthcare costs and providing patients access to effective, affordable therapies, Taiwan stands out as a respected leader in how to successfully work both sides of the equation.

Taiwan offers healthcare coverage to all of its citizens through its National Health Insurance (NHI) system. The single-payer insurance plan is very similar to those in the UK and Canada, but many believe that Taiwan’s system outperforms its counterparts, as its reimbursement element has consistently ranked number one in the world in terms of patient satisfaction – with patients receiving full coverage, high accessibility to care, and high quality of care.

Taiwan was the first country in Asia to implement a 100 percent reimbursement and HTA system more than 10 years ago, and its system now serves as the health insurance model for many other Asian countries. Taiwan is also home to many aggressive biotech companies, which focus on R&D and often sell or license innovation to the EU and United States.

Overcoming Challenges

Despite its success, Taiwan faces several significant healthcare challenges. These include a lack of sufficient budget for innovative, new medicines and barriers to patient accessibility for new treatments that have been amplified by a louder patient voice. These challenges are being driven by NHI budget constraints, which have resulted in more risk sharing policies, such as performance-based management and financial-based negotiation. Price adjustments are applied annually based on the Drug Expenditure Target (DET).

Still, more expensive and innovative medicines, such as immuno-oncology medicines, have found their way into the launch schedule. To pay for these innovative medicines, discussions are underway for approaches such as larger co-payments and balance billing. The involvement of varied stakeholders in the drug review process, as well as an increasingly empowered patient, are also affecting the market.

The impact to pharmaceutical companies include the need to develop a laser-sharp market access strategy. This includes addressing different key stakeholders’ perspectives to accelerate the drug review process; focusing more on self-pay strategies; maintaining price targets, as a lower price may trigger launch delays in Taiwan due to price referencing schemes; and focusing on real world outcome to demonstrate a medicine’s value.

Succeeding in Taiwan

In Taiwan, companies need to develop strong market access strategies, including cost-effectiveness analysis from local outcomes data, as well as patient support and communication. In real world evidence, crafting solid value stories in reimbursement submission dossiers, including precise budget impact assessments and cost-effectiveness analyses, is critical to success. To accelerate the reimbursement timeline, it’s essential to demonstrate cost-effectiveness from local real-world data for commercial communication or to support pricing negotiations with payers.

A patient-centricity framework, which combines patient insights with an outcome evaluation from the patient’s perspective, demonstrates a medicine’s value from epidemiology, patient QoL, disease burden, and treatment value perspectives. It also provides payers with a reference for medicine value evaluations, evidence for patient advocacy groups when they need to raise their voices about treatment access, and patient ecosystem insights so that pharma can develop better patient support systems.

Looking Forward

Taiwan is working hard to identify ways to keep insurance fees in check, with the country exploring performance-based management of medicines; co-payment reform, with South Korea and Japan as models; and the use of a Cloud platform to monitor medicine usage to reduce waste and prescription duplication. Additionally, healthcare reform may again be on the horizon with the possibility of a third generation of National Health Reimbursement in the next five years. The reform will focus on Managed Entry Agreements and co-payments, specifically for innovative new medicines.

For more information please be sure to check out Kantar Health's latest Edge of Insight report, Inside the Growth Markets, where Kantar Health takes an in-depth look at today's most attractive healthcare growth markets – China, Brazil, India, Korea, Taiwan, and Central and Eastern Europe – and details what steps pharma companies can take to optimize commercial success.

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