Drug dispensing policy under the spotlight

By Alison Hsiao  /  Staff reporter

Tue, Jul 30, 2013 - Page 3

As a new policy to increase public involvement in the process of drug dispensing and fees is enacted under the second-generation National Health Insurance (NHI), doubts have surfaced over the composition of the committee that oversees the policy.

Well into the second-generation NHI era and six months after the establishment of the Preparatory Office of the National Institute of Health Technology Assessment (NIHTA), the definition and role of the National Health Insurance Drug-Dispensing Items and Fee Schedule Joint Establishment Meeting is being put under the spotlight by a seminar held by the Taiwan Pharmaceutical Marketing and Management Association.

With the implementation of the second-generation NHI, regulations seeking to engage the public in the decisionmaking process of drug dispensing have also been enacted.

Shen Mao-ting (沈茂庭), director of the NHI Administration’s Medical Review and Pharmaceutical Benefits Division, said at the seminar that in an effort to achieve cross-party participation in decisionmaking, the Pharmaceutical Affairs Committee — the key actor in discussions of reimbursements for new drugs — which is comprised solely of medical and pharmaceutical specialists, has been replaced by the “Meeting.”

The amended National Health Insurance Act (全民健康保險法) states that: “Drug dispensing and fee schedules should be established jointly by the Insurer and the relevant agencies, experts, beneficiaries, employers and contracted medical care institutions; drug providers and relevant experts as well as patients, should also be invited to voice their opinions and report to the Competent Authority for approval.”

Chen Gau-tzu (陳昭姿), Koo Foundation Sun Yat-sen Cancer Center chief pharmacist, a three-time participant at the Meeting, said that one of the problems with the new process is that the use of technical terms in reports for appraisal have obstructed understanding of the issues and thwarted the involvement of representatives of the general public.

Regarding how public involvement in the process can be made more substantial and meaningful, National Health Insurance Civic Surveillance Alliance spokesperson Eva Teng (滕西華) highlighted the difference between a drug’s price and value, saying that the Meeting, as the Act stipulates, should consider health and ethics in addition to the costs of treatments and the financial implications of insurance.

Teng voiced concern about the composition of the Meeting — with half of attendees representing healthcare providers when the second-generation NHI went into effect — claiming that this would make price the sole criterion for decisions.

Re-emphasizing the role that the health authority has in laying down guiding principles for reimbursement priorities to facilitate discussions at the Meeting, Teng said that a value judgement on how cost-effectiveness, medical ethics and patients’ rights should be balanced is key.