The Evolution of HTA in Emerging Markets Health-Care ... - TREE

OHE Consulting Report for PhRMA
5 January 2011
to implement systems similar to other countries. The project has not really gained much traction
because the government already has tools—reference pricing and price surveillance—for controlling
drug prices.
It would be good if HTA could be used to establish efficient disease management or guidelines. But
Taiwan needs more time to develop a consensus on how to use HTA. There are ongoing hearings on
a new public law. The patient stakeholder group seems to support HTA as a rational process;
however, they don’t seem to realize that it is more likely that it will be used to reduce access to new
expensive, but innovative drugs.
The generic drug industry is robust in Taiwan and doubts that the research-­‐based industry will
support HTA. This is because there is pressure on the BNHI to provide access to new breakthrough
drugs, and the current median-­‐based external reference pricing (with a basket of 10 countries)
provides a reasonable price (from their perspective) for these drugs. The generic industry would
favour HTA for these drugs because it is likely to reduce prices on branded drugs and allow more
money for generics. They would also favour creating greater independence of the HTA unit from the
CDE.
The use of drugs is driven by the profit margin—the difference between what the NHI reimburses
and what the acquisition cost from wholesalers. The generic industry is concerned about opening
the market to generics made in China.
Academic View
Academic interviewees commented that, currently, Taiwan does not really have HTA. The only
guideline is from ISPOR in Taiwan: there is no official government guideline. Neither the BNHI nor
the DHTA unit in the CDE is lobbying strongly for a greater role for HTA. They do not really seem to
want to be accountable to the public.
DHTA currently conducts literature review and summarizes the evidence from other countries as
outlined above; it does not do a local pharmacoeconomic analysis. Knowledge about this process is
very limited and manufacturers have no access to this report and no opportunity to challenge it. If
properly set up, HTA could help to provide a better, efficient resource allocation of health care
resources. The BNHI currently exploits its monopsony power.
HTA is a rational policy, and should be applied to all drugs, not just new ones. But BNHI only worries
about the financial costs, and does not pay much attention to efficiency, i.e., health gain for the
money spent.
Reform of the NHI is under discussion but the focus is on finance and the insurance premium, not
HTA. The current working on HTA is vague: the BNHI could apply it in the appraisal and pricing of
new drugs. The public representatives support it as a rational and scientific approach that would
also help to combat bureaucracy and corruption.
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