Exploring the drug reimbursement scheme in Taiwan to provide increased access to pharmaceutical treatments for Taiwanese patients.
In 2017 alone Taiwan’s National Health Expenditure accounted for 6.4 percent of gross domestic product (GDP) which amounts to US$ 37.5 billion. This was an increase of 3.7 percent from the previous year. Majority of Taiwan’s Healthcare expenditure is funded by the public sector, making up 60.8 percent of all healthcare expenditure.1 First instituted in 1995, the National Health Insurance Scheme in Taiwan has provided a single-payer system with compulsory enrolment including low out-of-pocket payment by those who are insured and is operated by the government. Together with the National Health Insurance Scheme, the drug reimbursement scheme was also implemented.
In January 2019, the Taiwan Food and Drug Administration approved Biktarvy which is a combination of three medications (bictegravir, emtricitabine, tenofovir alafenamide) that is used as a prescription drug for adults with HIV-1 infection. Later in September 2019 it was announced that Biktarvy was approved by the Taiwan National Health Insurance Scheme for reimbursement and would be made available on 1st October 2019.2
To elucidate on the recent approval of Biktarvy – a once-daily single tablet treatment of HIV-1 infection in adults – by the Taiwan National Health Insurance Administration, are Mr Pongo Peng, General Manager, Gilead Taiwan, and Mr David Lin, Medical Affairs Director, Gilead Taiwan and how will this approval impact HIV patients in Taiwan.
What factors or clinical studies are considered when a treatment is approved by the Taiwan National Health Insurance administration?
While we do not know what factors or clinical studies were considered when NHI made the decision, in general, reimbursement agencies tend to review the safety profile and efficacy of the applicant drug, followed by broader, long-term clinical benefits and health economic impact to targeted patient population and health system.
Drug resistance, toxicity and drug-to-drug interactions are typical challenges in HIV treatment: sustained suppression of the viral load over time is a key goal.
Biktarvy has, in our global clinical studies in both treatment-naïve and immunosuppressed patients, demonstrated good tolerability, efficacy, durability, as well as a high barrier to resistance and few drug-to-drug interactions. These benefits support the long-term health of patients, reduction in viral transmission, and potentially, ending of the HIV epidemic. We are encouraged and delighted to be able to provide a solution such as Biktarvy in working towards the end goal of elimination of HIV endemic.
How does the reimbursement approval of Biktarvy in Taiwan impact patients with HIV-1 infection and help Taiwan be on track to achieving the UNAIDS 90-90-90 goals in the fight against HIV epidemic?
Taiwan government’s progressive policies and adoption of innovative HIV medicines, spearheaded by the Ministry of Health & Welfare and its agencies such as the Taiwan Centers of Disease Control (CDC), have made significant achievement in the fight against HIV. The year-on-year decline in prevalence and new infection rates is a result of these efforts.3 As of December 2018, Taiwan is on track to achieving the 90-90-90 goals with 84 percent of people living with HIV in Taiwan diagnosed, 88 percent of diagnosed people on antiretroviral treatment and 94 percent of them in treatment with fully suppressed viral load.4
We believe the reimbursement approval can accelerate the progress in achieving the full 90-90-90 goals, closing the gaps in the first and second 90 but also to further improve the fourth 90 (health-related Quality of Life). Global studies have shown that individuals on effective antiretroviral medication with sustained undetectable viral load do not represent risk of transmitting HIV to others.5 If we can get more infected patients on treatment more rapidly immediately after testing, we can improve adherence rates, and can effectively curtail the spread of the disease and potentially end it, which is aligned with Taiwan CDC policy of rapid initiation.
Having access to treatment is but one part of the equation; getting patients tested and on treatment rapidly is another piece of the challenge that we need to work to solve, and the reimbursement signifies a positive step in this rapid cascade of care that is a key measure in ending HIV.
What are the barriers that prevent or deter patients from seeking treatment?
The progress that had been made in HIV treatment over the last 30 years has had tremendous health and social impact on the lives of people living with HIV. Today, HIV is viewed as a chronic disease and people living with HIV can live a normal life expectancy.
However, there continues to be persistent systemic challenges from lack of resources, absence of healthcare services at community level, to access and societal stigma, that stand in the way of society making greater progress in getting more people tested and treated – and preventing new infections. In some conservative cultures, for instance, there is a lack of sexual health education and disease awareness. All these lead to patients not seeking treatment, or presenting late to care – at which stage, oftentimes, would have progressed to AIDS.
This points to the governments, payors, healthcare professionals and the industry to work collectively to address these societal barriers to care, prioritise HIV as a public health issue to ensure that not only are the latest drugs be made available, but that patients stay engaged throughout the care continuum. We have the tools – i.e. innovative treatments – today to end HIV but getting these tools in the hands of people that need them most proves to be challenging.
In what ways will Gilead continue to deliver innovative treatments for HIV patients in Taiwan?
Gilead’s work in HIV spans the full continuum of HIV care – from prevention to treatment to cure research. We pioneered the first single tablet regimen HIV treatment and developed medicine to prevent HIV. We are working tirelessly and relentlessly in our pursuit of the next transformative breakthrough in HIV. We are presently working on long-acting injectables as well as potential cure.
Research aside, we partner with our allies – Taiwan’s government, civil society, healthcare community, patients and caregivers -- to address the root causes driving the HIV epidemic and are working to ensure that people living with HIV, and those at risk of infection, have access to Gilead’s prevention and treatment options. To do more, Gilead has also dedicated significant resources through grants, such as the Gilead Asia Pacific Rainbow Grant, to support Taiwan’s HIV non-profit organisations and their programmes aimed at tackling unmet needs and advancing the delivery of care for the HIV community.
- US Commercial Service, (2019, Oct), Healthcare Resource Guide: Taiwan. Retrieved from: https://2016.export.gov/industry/health/healthcareresourceguide/eg_main_108622.asp
- Asia-Pacific Biotech News, (2019, Nov), Gilead Sciences, Inc. announces Biktarvy® is now available via the National Health Insurance scheme in Taiwan. Retrieved from: http://www.asiabiotech.com/23/2311/23110047b.shtml
- Taiwan National Infectious Disease Statistics System. Taiwan Centers for Disease Control, 2019. Retrieved from: https://nidss.cdc.gov.tw/en/SingleDisease.aspx?dc=1&dt=3&disease=044
- Taiwan Centers for Disease Control, (2018, Dec 5), Beat AIDS and be Healthy Together – Taiwan CDC urges the public to create an open and friendly environment for HIV testing. Retrieved from: https://www.cdc.gov.tw/En/Bulletin/Detail/0afA_nz1r1QpyJCDxNKxaw?typeid=158
- Rodger, A.J. et al, 2019. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. The Lancet v393(10189) p2428-p2438. Accessed online: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30418-0/fulltext