Self-pay price gaps in cancer medicines: hospital pricing differences and institutional thinking on patient access

By Evie Wang, COO of PatientsForce

In Taiwan's cancer care system, many high-cost anticancer medicines are covered by national health insurance, but patients who do not meet reimbursement criteria still pay out of pocket — and self-pay prices have long differed across hospitals. The pricing spread for cancer targeted therapies among Taiwan's hospitals is significant and well worth study.

Using a sample of 90 hospitals nationwide, the study analyzed two reimbursed oral targeted therapies against the NHI reference price. Hospital prices for the lung-cancer targeted therapy ran 0% to 30% above the reference price, with a median around 20%; for the breast-cancer therapy, 0% to 37% with a median around 15%. Markups showed statistically significant associations with hospital system, religious affiliation and regional market structure: public university-affiliated hospitals and some religiously affiliated hospitals were relatively more likely to take high markups, and clear differences appeared across NHI administrative regions.

The differences in hospital self-pay pricing partly reflect gaps in regional medical resources and market competition. In regions where resources are concentrated, competition and pricing strategy interact differently; in the breast-cancer market where competing products exist, county-level market concentration (HHI) remains significantly correlated with markups.

For pharmaceutical professionals, the study reveals an often-overlooked phenomenon: even after NHI price negotiation and supply-chain adjustments — amid industry talk of the 'drug price black hole' — price differences persist at the hospital where patients finally obtain their medicine. Access, in other words, depends not only on reimbursement listing but also on hospital pricing strategy.

This raises a further question for industry and policy: when patients must self-pay, releasing prescriptions from hospitals so that community pharmacies and market channels can supply self-pay medicines may better serve patient interests. Some international health systems divide labor between hospitals and community pharmacies, letting patients fill prescriptions through different channels at more market-flexible prices. For Taiwan, this discussion touches not only drug-price governance but hospital governance, distribution management and fairness of access. As new cancer medicines keep launching and treatment costs climb, balancing quality and market mechanisms will become a shared concern of policy and industry.

Meanwhile, pharmaceutical companies have used patient assistance programs (PAP) to ease the burden — medication education, therapy support or partial financial assistance. But with new cancer medicines costing tens of thousands to over a hundred thousand NT dollars per month, self-pay treatment remains heavy for patients outside reimbursement criteria. With hospital price gaps of up to 30%, a year-long course of some oral targeted therapies could cost a patient nearly NT$300,000 more depending on where they are treated.

Even with PAP support, such gaps are hard to fully offset. If future institutional design introduces more transparent market mechanisms — for example, compliant prescription release from hospitals so patients can obtain medicines through different pharmacy channels — prices may move closer to competitive levels while maintaining quality and safety, further improving access to cancer treatment.

Reference: Wang, E. (2025). Factors associated with self-pay markups on cancer medicines in Taiwan hospitals. Master's thesis, Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University.