pLOG

2025-06-11

Helping Patients Bridge the National Health Insurance Gap: Patientsforce’s Innovative Solution

The National Health Insurance Administration under Taiwan’s Ministry of Health and Welfare recently announced plans to expand reimbursement coverage for several medications starting June 1, 2025. The list includes cancer immunotherapy drugs; Olaparib-based targeted therapies for ovarian, pancreatic, prostate, and breast cancers; Bevacizumab-based therapies for ovarian cancer; and the monoclonal antibody Palivizumab for preventing respiratory syncytial virus (RSV) infection in premature infants. Many of these drugs are currently part of Patientsforce’s Patient Assistance Program (PAP), which helps patients access treatment during the out-of-pocket phase. While this expansion brings hope to patients who have long been waiting, it also underscores the persistent barriers between regulatory approval and widespread access to new therapies.

Overview of Taiwan’s Specialty Drug Market and the Long Wait for Reimbursement Approval

In the face of the reimbursement gap prior to National Health Insurance coverage—and potential limitations such as quota restrictions or special conditions even after coverage is granted—Patientsforce’s Patient Assistance Program (PAP) offers a comprehensive solution that supports both pharmaceutical companies and patients.

However, the process of securing National Health Insurance (NHI) reimbursement for new drugs in Taiwan is often lengthy. Pharmaceutical companies can only submit reimbursement applications to the National Health Insurance Administration (NHIA) after obtaining market approval from the Taiwan Food and Drug Administration (TFDA). The subsequent review process—including Health Technology Assessment (HTA), expert panel discussions, and the Pharmaceutical Benefits and Reimbursement Scheme (PBRS) meetings—involves complex negotiations and rigorous evaluations.

According to past data analyses, it typically takes over 400 days from application submission to formal reimbursement approval, with wait times for cancer drugs often exceeding 700 days. Although the NHIA has made efforts in recent years to accelerate the process—such as implementing parallel reviews for certain medications with a target timeline of 6 to 10 months—unpredictable delays and case-by-case variations still persist. This “gap period” can limit patients’ access to optimal treatment and introduce uncertainty for pharmaceutical companies in terms of market planning and revenue projections.

A Market Accelerator for Pharma and a Safety Net for Patients

In light of the reimbursement gap before National Health Insurance coverage—and potential post-coverage restrictions such as quota limits or special eligibility criteria—Patientsforce’s Patient Assistance Program (PAP) serves as a comprehensive solution, acting both as a market accelerator for pharmaceutical companies and a safety net for patients.

Value for pharmaceutical companies::

  1. Compliant and rapid entry into the self-pay market:: Helping pharmaceutical companies quickly establish a presence in the self-pay market by strictly complying with regulations, reaching early adopters, and building brand awareness.
  2. Flexible support system: We provide a standardized, modular, and customizable support system that can flexibly adapt to the operational workflows of different hospital levels, physicians’ prescribing habits, and patients’ individualized medical needs and financial situations.
  3. Improving drug accessibility and affordability: By providing financial assistance and medication donations, we reduce the barriers for patients to access treatment and expand the availability of medications.
  4. Flexible cost-sharing programs: For drugs with partial insurance coverage or reimbursement limits, a "pre-enrollment with subsequent support" model can be designed—for example, subsidizing patients’ out-of-pocket expenses or providing assistance after the annual reimbursement quota is exhausted.
  5. Real-world data accumulation: The implementation of the PAP program helps collect real-world data (RWD) and real-world evidence (RWE) on patient medication use, which are highly valuable for subsequent health insurance negotiations, market strategy adjustments, and academic research.

Value for patients:

  1. Reducing financial burden: Directly lowering the financial barriers to out-of-pocket medications, helping to prevent the “financial toxicity” that can lead to poverty due to illness.
  2. Early access to innovative treatments: Avoiding delays in receiving critical treatment caused by waiting for insurance reimbursement approval.
  3. Improving treatment adherence: A stable supply of medication and financial support help patients complete their prescribed treatment regimens, enhancing therapeutic outcomes.

Market Innovation in Medication Accessibility

In the foreseeable future, as more high-cost innovative drugs emerge, the limited resources of the National Health Insurance system and rigorous review processes will make the “reimbursement gap” a common occurrence. Within this market context, the strategic value of the PAP program becomes increasingly apparent:

  1. A Key Driver for Market Access:Patientsforce helps pharmaceutical companies shorten the time from product launch to actual sales in a highly competitive market, enabling them to seize early market opportunities.
  2. Maximizing the lifecycle value of medications: From early-stage education in the out-of-pocket market to supplemental support after insurance reimbursement, the PAP program effectively extends the market longevity and revenue contribution of medications.
  3. Stable market demand: The ongoing demand from patients for innovative treatments and financial support provides a stable market foundation for PAP services.
  4. Enhancing corporate social responsibility and brand image: By giving back to society and supporting patients in need through the PAP program, pharmaceutical companies concretely fulfill their corporate social responsibility (CSR), effectively enhancing their public image and brand reputation.

The reimbursement gap is a common challenge facing the pharmaceutical industry today. Through professional, compliant, and innovative patient assistance programs, an effective bridge can be built between pharmaceutical companies, healthcare institutions, and patients, shortening the waiting time for patients to access innovative treatments.
Note: The review timeline for new drugs to be included in National Health Insurance reimbursement varies by case. The days cited here are averages or medians referenced from past academic studies or industry reports. Please refer to official announcements from the National Health Insurance Administration for actual timelines.


References:


  • Lin, Y. J., et al. (2018). New Drug Reimbursement and Pricing Policy in Taiwan. Journal of Forming Medical Association.(Referencing an average of 742 days for cancer drugs)
  • Chen, L. F., et al. (2020). Reimbursement Lag of New Drugs Under Taiwan's National Health Insurance System Compared With United Kingdom, Canada, Australia, Japan, and South Korea. Clinical Therapeutics. (Referencing a median of 458 days under the second-generation National Health Insurance system)
  • Announcements from the National Health Insurance Administration, Ministry of Health and Welfare (referencing the target timeline for parallel review).
  • NHI June Reform | Expanded Coverage for Immunotherapy and Targeted Drugs Benefits Four Cancers Including Ovarian Cancer, Zhi News, June 1, 20241 https://www.knews.com.tw/news/F3C18771F145FB272E60F41847BB33F1