Page 53 - 2018-19全民健康保險年報

Payment Coverage for New Hepatitis C Oral Drug
In the past, hepatitis C treatment required the injection of peginterferon once a week, coupled with daily oral intake of ribavirin. The treatment session lasts from six months to a one year. The introduction of the new hepatitis c full oral drug can improve, the cure rate, reduce side effects, and reduce the course of treatment. The NHI has since January 2017 included it in the coverage. In 2017, the NHI global budget allocated of NT$2.43 billion to cover the new hepatitis c full oral drug to cover prioritized patients recommended by the Gastroenterological Society of Taiwan, benefiting about 9,538 cases. In addition, a budget of NT$ 4.73 billion was allocated in 2018 for to cover this new hepatitis c full oral drug benefiting 18,000 cases. Moreover, depending on the financial impact and treatment effectiveness, the application scope will be gradually expanded.
Special Medical Materials with Balance Billing
Although some new medical devices offer improved functions, they are often far more expensive than existing similar items in the NHI fee schedule. To ease the financial burden of patients who benefit from these new medical devices and give them more choices, beginning 1995, newly added functional categories have been listed as balance billing items, including artificial heart rhythm regulator, applicators and special coated vascular
專業審查 提升品質
Professional Review and Quality Improvement
stent, special material artificial hip joint (ceramic material), special function artificial crystal, durable biological tissue heart valve, regulated ventricle abdominal drainage system, applicator device for treating superficial femoral artery stenosis, customized computer-assisted cranial bone fixation system, ablation catheters for treating arterial fibrillation, and GAMA Nail (long), (10 items in total). (Table 4-1). Whenever an insured person wishes to use the more costly medical devices or materials, NHI will provide reimbursement in accordance with the payment standards of existing similar items, and the rest parts are out of patients’ pocket. In order to protect the public’s rights and interests, hospitals and clinics must provide the consumer with adequate information of this new medical device before performing surgery or treatment in such cases.
In addition, hospitals and clinics must post information including the names, item codes, fee standards (including out-of-pocket payment, NHI payment prices, and copayments), and product characteristics, side effects, and therapeutic effects comparison with items already covered by the NHI on their websites. The NHIA will also provide information concerning balance billing materials on its website. The public is able to obtain the prices of such balance billing materials at hospitals in the “Price Comparison Platform of Self-Paid Medical Devices” section of the NHIA’s website.
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