By Evie Wang, COO of PatientsForce

In Taiwan’s cancer treatment system, although many high-priced anti-cancer drugs have been included in the health insurance benefits, when patients do not meet the payment conditions, they still need to pay for the drugs out of pocket.

The study used 90 hospitals in Taiwan as a sample to analyze the price assurance of two oral targeted drugs that have been included in the health insurance benefits. The results showed that the pricing of targeted drugs for lung cancer in hospitals was between 0% and 30% higher than the approved price of health insurance, with a median of about 20%. Breast cancer targeted drugs range from 0% to 37%, with a median of about 15%. Further analysis found that there was a statistically significant correlation between the markup and the hospital system, religious attributes, and regional market structure. For example, the proportion of hospitals affiliated with public universities and some hospitals with religious backgrounds adopting high markups is relatively high, and there are also significant differences between different health insurance business divisions.

The study pointed out that the difference in hospital self-funded pricing also reflects the gap between Taiwan’s regional medical resources and the competitive environment in the market to some extent. In some areas where medical resources are more concentrated, the degree of market competition and price strategy are different, and in the breast cancer drug market where competing products exist, the market concentration (HHI) at the county and city level is still significantly correlated with the pricing markup.

For pharmaceutical practitioners, this study also reveals a phenomenon that is often overlooked: while the industry is widely discussing the “black hole of drug prices”, even if the drug has gone through health insurance negotiations and supply chain price adjustments, there is still a price difference at the hospital side when patients finally obtain the drug. In other words, the accessibility of a drug depends not only on whether it is included in the payment, but also closely related to the hospital’s pricing strategy.

In this context, the research also raises another topic worthy of industry and policy discussion: when patients have to pay for their own medicines, hospitals issue prescriptions, and community pharmacies or market channels supply self-funded drugsIt should be more in the interests of patients. Some international medical systems adopt a division of labor between hospitals and community pharmacies, allowing patients to obtain drugs through different channels according to prescriptions, and the prices are more flexible in the market. For Taiwan, such institutional discussions not only involve drug price management, but also involve hospital governance models, drug circulation management, and fairness in patient access to treatment. As new cancer drugs continue to emerge and treatment costs increase year by year, how to strike a balance between medical quality and market mechanisms may become an important issue of common concern to medical policies and industries in the future.

On the other hand, in recent years, pharmaceutical companies have helped patients reduce the burden of medication to a certain extent through patient assistance programs (PAPs), such as providing medication education, treatment support, or partial cost assistance. However, with the price of new cancer drugs often reaching tens of thousands or even more than 100,000 yuan per month, if patients do not meet the conditions for health insurance benefits, self-funded treatment itself is still a heavy burden. When there is a price gap of up to 30% between different hospitals, patients may increase their expenses by nearly 30 yuan based on a one-year course of some oral targeted drugs.

In such a scenario, even if PAP can provide some level of support, it is still difficult to fully offset the impact of price differences. If more transparent free market mechanisms can be introduced in the future in the system design, such as releasing prescriptions from hospitals under the premise of compliance and allowing patients to obtain drugs through different pharmaceutical channels, there may be opportunities to maintain medical quality and drug safety, while bringing prices closer to market competition levels, further improving the accessibility of cancer treatment.

References

• Wang Yiwen, Exploring the Factors Associated with the Out-of-pocket Cancer Drug Surcharge in Taiwan Hospitals, Master’s Thesis, Institute of Health Management, Yang Ming Chiao Tung University, 2025