gms | German Medical Science

Background: Taiwan National Health Insurance (NHI) launched in 1995, and has been in operation for over 20 years, with a coverage rate of 99.9% citizens. However, with the population aging, the socio-economic environment changing, and the health technology progressing, NHI expenditures have increased from NT$458.2 billion (US$14.32 billion) in 2011 to NT$727.4 billion (US$22.74 billion) in 2021. In recent years, emerging high-priced treatments such as CAR-T therapy have appeared, what’s more, some treatments requiring specialized hospital facilities, nuclear medicine disposal, and companion diagnostics. As a result, Taiwan has applied Horizon Scanning (HS) methodology to budget planning for new drugs in recent years, aiming to allocate medical resources more reasonably while balancing patients’ rights to medication and ensuring the sustainability of the NHI.

Objective and Methods: Our study aims to demonstrate the application of HS in Taiwan’s NHI system. We reviewed the evolution of HS methodology applied to the NHI system and explored the differences between before and after adopting HS methodology in budget planning.

Results: Taiwan began to explore the early awareness and alert system methodology in 2017. In 2018, we established a horizon scanning methodology for new health technologies and conducted identification, filtration, prioritization, assessment, and dissemination for new drugs submitted in 2016 and 2017, implementing a first pilot study. In 2019, we conducted a second pilot study, which increased the screening frequency, and added reimbursement conditions, compared to the first study, and also compared previous HS assessment results with actual drug expenditures. By 2020, NHI further collaborated with the stakeholders and developed a “Horizon Scanning Platform”. Before 2021, Taiwan’s new drug budget was retrospectively estimated using the replacement rate of each drug category for the following year’s drug budget. However, when planning new drug budget for 2022, NHI adopted HS methodology, calculating individual replacement rates based on the clinical need of each drug, and also referred to data on the HS platform submitted by stakeholders, records of pharmaceutical benefit and reimbursement scheme joint committee, HTA reports, and NHI drug claims data.

Conclusion: Using HS methodology and establishing HS Platform can effectively identify drugs likely to be included in future coverage, allowing for early budget planning and predicting the impact of relevant health technologies on the healthcare system and the potential budget impact.