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

OHE Consulting Report for PhRMA
5 January 2011
of new health technologies, often by 2 years and at times 5 years (but no longer than that). To
control the rising expenditures on pharmaceuticals, the BNHI has introduced various strategies to
control health expenditure including: internal reference pricing (i.e., generic grouping based on the
notion of ‘chemical equivalence’), external (international) reference pricing (based on prices of
products in ten international reference countries), market price and volume surveys, and global
budget payment for clinics and hospitals.
A3.5 Pharmaceutical Distribution
Those in Taiwan can get prescription drugs from a variety of sources including private clinics, state-­licensed
pharmacies, and general hospitals. Doctors are the primary prescribers although
pharmacists can provide over-­‐the-­‐counter medications. These medications range from traditional
herbal remedies to modern western pharmaceuticals.
Since the acquisition cost of the medication is almost always less than the reimbursement cost (from
NHI), there is an incentive for hospitals and practitioners to overprescribe medications. In fact, a
patient seldom leaves a visit to a doctor without a handful of prescription drugs. Of course, cultural
factors and expectations probably play a large role in this as well. As noted above in Table 1, a large
share of revenue from outpatients comes from drugs. As a result, there is an overuse of drugs,
resulting in health problems, such as a high rate of immunity to antibiotics to those who need it.
Hospitals are reimbursed by the BNH according to the price list. Each hospital is reimbursed the by
same amount for the same prescription. However, each hospital has its own acquisition cost
through bargaining with the drug companies. Thus, larger hospitals, such as medical centres, with
strong bargaining power are able to obtain drugs at a relatively low price.
A3.6 Incorporation of New Drugs in the Taiwanese Health Care
System
Figure 3 represents the relationship among the government bodies involved in the drug review and
HTA process (though the BPA was integrated into the TFDA in January, 2010). The process for
introducing a new drug to the Taiwanese Health Care System is managed by the Drug Benefit
Committee (DBC). It is comprised of experts from disciplines including physicians, pharmacists, and
economists; in total, there are 24 members (5 officers and 19 medical professionals). Every month,
the DBC meets to discuss applications for new drugs submitted by manufacturers, each of which is
assigned to 2 of the 19 medical professionals for review. Within 2 weeks, the medical professionals
assigned to the drug application submit a review for the rest of the committee to consider. The
entire committee then comes together 4 to 6 months later to discuss the proposed drug.
When the Minster of Health announced the upcoming pilot program of evidence-­‐based decision
making, he stressed that it would not prolong the process. A year later in 2008, a Health Technology
Assessment (HTA) program was established in probationary form and the evaluation of drugs was to
be accelerated to an average of 3 months. Apparently, the HTA team completes product evaluation
in about 42 days, on average, while the review by DBC still takes longer than three months.
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