Mon, Sep 02, 2024 page3

• NHI to cover EGFR-mutated lung cancer

  CHANGES: With the expansion, people with stage 3b EGFR-mutated lung cancer would be eligible for Tagrisso, a drug that can more effectively reduce the risk of mortality

  • By Lin Hui-chin / Staff reporter
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  The National Health Insurance Administration (NHIA) said it plans to expand the coverage eligibility for receiving a third-generation targeted drug for lung cancer patients with the epidermal growth factor receptor (EGFR) starting next month.

  The eligibility would be expanded to include people with stage 3b EGFR-mutated lung cancer, which is expected to benefit about 4,000 people, allowing them to save about NT$1.15 million (US$36,005) per year in medical expenses.

  The expanded eligibility is expected to cost the NHI program between NT$4.1 billion and NT$5 billion per year, and with the annual expense of about NT$3.3 billion on eligible patients, the targeted drug would be the most expensive single type of drug in NHI history.

  

  The National Health Insurance Administration logo is pictured in an undated photograph.

  Photo: Chiu Chih-jou, Taipei Times

  Lung adenocarcinoma is the most common type of lung cancer in Taiwan and KRAS mutations occur in about 20 to 40 percent of lung adenocarcinomas in Western populations, NHIA Director-General Shih Chung-liang (石崇良) said.

  However, in Taiwan, KRAS mutations only occur in about 8 to 10 percent of patients with lung adenocarcinomas, while EGFR mutations occur in about 55 to 60 percent of patients with lung adenocarcinomas, he said.

  The NHI program since April 2020 has conditionally covered a third-generation targeted drug called Tagrisso (osimertinib) for the treatment of EGFR-mutated lung cancer, but the eligibility was reduced in April 2022, which had caused an uproar among patients and medical professionals.

  Studies published in international journals have suggested that compared with the first-generation targeted drug, the third-generation drug can reduce the risk of mortality by 20 percent.

  With many calls for the NHI program to expand eligibility, Shih said the administration plans to expand the eligibility of Tagrisso from its current eligibility of stage 4 (metastasized) lung cancer to include stage 3b EGFR-mutated lung cancer with local invasiveness or metastases.

  The Pharmaceutical Benefit and Reimbursement Scheme Joint Committee has approved the expanded eligibility, and it is scheduled to take effect on Oct. 1 at the earliest, he said.

  About 3,400 people are treated with Tagrisso each year, which is an NHI expenditure of about NT$3.3 billion per year, NHIA statistics showed. After the eligibility expansion, it would increase the expenditure to more than NT$7 billion.

  The total expenditure for NHI-covered medical treatment last year was more than NT$24.3 billion, the highest among all cancer types, and drug fees accounted for NT$12.2 billion, with a five-year average growth rate of 12.7 percent.

  Regarding people with lung cancer without gene mutations that cannot receive the targeted drug, Shih said specialists have suggested including immunotherapy drugs for treating metastasized small cell lung cancer in NHI coverage, so there might be good news after the agency negotiates with drug companies.

  An estimated 272 to 359 patients each year are expected to benefit from it, allowing them to save about NT$1.45 million per person per year, he added.
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