Reimbursement Lag of New Drugs Under Taiwan's National Health Insurance System Compared With United Kingdom, Canada, Australia, Japan, and South Korea

Abstract

Drug lag—delayed approval or reimbursement—is a major barrier to accessing cutting‐edge drugs. Unlike approval lag, reimbursement lag is under‐researched. We investigated the key determinants of reimbursement lag under Taiwan National Health Insurance (NHI), and compared this lag with those in the United Kingdom, Canada, Australia, Japan, and South Korea. Using retrospective data on 190 new NHI‐reimbursed drugs from 2007 to 2014, we studied reimbursement lag in Taiwan vs. other countries, and investigated associated factors using generalized linear models (GLMs). The median reimbursement lags during before (“first‐generation”) and after (“second‐generation”) NHI drug reimbursement scheme in Taiwan were 378 and 458 days, respectively. The “first‐generation” lag was shorter only than that in South Korea, whereas the “second‐generation” lag only exceeded those of the United Kingdom and Japan. In GLM models, higher drug expenditure and the introduction of the “second‐generation” NHI were two statistically significant parameters associated with reimbursement lag among antineoplastic and immunomodulating agents. For other drug classes, the reimbursement price proposed by pharmaceutical companies and use of price‐volume agreements were two statistically significant parameters associated with longer reimbursement lags. The current reimbursement lag in Taiwan is longer than 1 year, but only longer than those of the United Kingdom and Japan. The determinants differ between drug categories. A specific review process for antineoplastic and immunomodulating drugs may expedite reimbursement. There is a clear need for systematic data collection and analysis to ascertain factors associated with reimbursement lag and thereby inform future policy making.

Health insurance coverage and timely antenatal care attendance in sub-Saharan Africa

“…For example, countries such as China which has a population of over 1.3 billion people ensures health insurance coverage for its populace [ 7 ]. Several countries including the USA [ 8 ], Taiwan [ 9 ], and France [ 10 ] have all instituted national health insurance. In sub-Saharan Africa (SSA), countries like Ghana [ 3 ] and Nigeria [ 11 ] have health insurance schemes that aims to promote UHC and limit catastrophic health expenditure.…”

Factors Affecting Usage Levels and Trends of Innovative Oncology Drugs Upon and After Reimbursement Under Taiwan National Health Insurance: Interrupted Time Series Analysis

“…Off‐label prescriptions outside of the reimbursement scheme are not allowed. Routine audit for off‐label prescription is conducted by the NHIA and the corresponding fine is issued to contracted medical institutions or physicians 20,21 …”

“…Routine audit for off-label prescription is conducted by the NHIA and the corresponding fine is issued to contracted medical institutions or physicians. 20,21…”

“…As these reimbursement criteria detail the coverage restrictions of innovative oncology drugs, we hypothesized that changes to these criteria (endogenous factor) would be associated with changed utilization of these drugs. Under Taiwan's universal healthcare coverage scheme, [19][20][21] new drugs are specifically required to compete with other indicated drugs (exogenous factor) in a single national market. We hypothesized that reimbursement of a new drug may diminish utilization of other drugs in the same therapeutic class.…”

Drug Lag and Associated Factors for Approved Drugs in Korea Compared with the United States

“…Therefore, it is important to facilitate the accessibility of key innovative drugs developed overseas through timely regulatory approval for public health. Indeed, disparities in drug access between regions have been studied for implications in many countries [ 6 , 7 , 20 , 21 , 22 ].…”