Starting from May 1st, the National Health Insurance (NHI) Payment Have Been Covering Next-Generation Sequencing for Solid Cancer and Leukemia as Part of Precision Medicine for Cancer Treatment, Benefitting over 20,000 Patients
The Ministry of Health and Welfare announced the inclusion of next-generation sequencing (NGS) in the NHI payment program starting on May 1st, 2024. According to the National Health Insurance Administration (NHIA), this measure is estimated to benefit over 20,000 cancer patients per year, with a budget of approximately NT$300 million. The new measure aligns the NHI program with the trend of applying precision medicine for cancer treatment.
Gene testing serves various purposes. There are 14 types of cancer for which single gene testing or Next-Generation Sequencing (NGS) can aid in the selection of appropriate targeted therapy drugs. Depending on the testing methods employed, the number of gene loci involved, and other patient-specific requirements, the test may be covered by the National Health Insurance (NHI) through a fixed-amount reimbursement, with an out-of-pocket balance payment required. The NHI fixed-amount reimbursement encompasses tests for the BRCA gene, with a small panel (≤ 100 genes) and a large panel (> 100 genes), offering 10,000 points, 20,000 points, and 30,000 points, respectively. NGS covers nine solid tumors, namely non-small cell lung cancer, triple-negative breast cancer, ovarian cancer/fallopian tube cancer/primary peritoneal cancer, prostate cancer, pancreatic cancer, solid tumors with the fused NTRK gene, intrahepatic cholangiocarcinoma, thyroid cancer, and medullary thyroid cancer. For colorectal cancer, urothelial carcinoma cancer, melanoma, gastrointestinal stromal tumor, and stomach cancer, the consensus reached in expert meetings is to utilize single gene tests to optimize NHI payment effectiveness. Relevant medical associations have submitted applications in accordance with the relevant procedural regulations.
Gene testing plays a pivotal role in hematological tumors, aiding in the development of follow-up treatment plans, including the assessment of suitability for bone marrow transplants. The revised payment policy now extends coverage to both small panel (≤ 100 genes) and large panel (> 100 genes) Next-Generation Sequencing (NGS) tests. Gene tests are particularly relevant for five primary types of hematological tumors: acute myeloid leukemia (AML), high-risk myelodysplastic syndrome (MDS), acute lymphoblastic leukemia (B-ALL and T-ALL), B-cell lymphoma (BCL), and NK-/T-cell lymphoma/leukemia (NKTL). For B-cell lymphoma and NK-/T-cell lymphoma/leukemia, single gene tests are planned for employment. Relevant medical associations have already submitted the necessary applications in line with the new policy.
Timing for cancer testing varies depending on the type of cancer, and payment regulations have been established to specify the indications and genes to be tested for each type. Each patient is entitled to one National Health Insurance (NHI)-covered test for each type of cancer in their lifetime. To ensure test quality, claims can only be submitted by regional or higher-level hospitals, or hospitals with cancer-care quality certification, listed in the Ministry of Health and Welfare's approved Laboratory Developed Tests (LDTs) implementation plan. Furthermore, hospitals are mandated to establish a Molecular Tumor Board (MTB), either independently or in collaboration with other facilities. The MTB aims to enhance clinical interdisciplinary collaboration, facilitating precise and personalized treatment strategies for patients with different indications
The National Health Insurance Administration (NHIA) has mandated that medical facilities upload all test results to ensure the quality of tests and evaluate the response and effectiveness of drugs covered by the NHI program. These uploaded data serve as crucial references for determining payment effectiveness and adjusting payment policies. In the future, as new targeted therapy drugs are incorporated into the NHI payment package, a database will enable inquiries with comparisons of applicable conditions and real-time medication information. This eliminates the need for patients to undergo repeated examinations, thereby enhancing treatment effectiveness and reducing economic burdens on patients. Furthermore, the NHIA is planning to commission a nationally leveled biobank platform to facilitate matching for clinical trials and new drugs, providing timely treatment opportunities for the public
As Taiwan transitions into a super-aged society, accompanied by a rapid rise in cancer treatment costs, Next-Generation Sequencing (NGS) emerges as a vital component of precision medicine, safeguarding the rights to medical treatment and health benefits for the public. The National Health Insurance Administration (NHIA) is leading the promotion of precision testing, assisting doctors in formulating personalized treatment strategies, and establishing a nationwide biobank. These initiatives aim to enhance the NHI payment program and cultivate an ecosystem conducive to precision medicine.
Via@NHI Website