【Media Coverage】CNA — 2025 Hepatitis C Elimination / National Health Insurance Price Cuts to One-Tenth Prove Effective: New Hepatitis C Drugs Drop from Over NT$2 Million to NT$250,000

2025.12.07(CNA reporters Chieh-Ling Chen and Pei-Yao Shen, Taipei, Dec. 7)

Taiwan is accelerating toward its goal of eliminating hepatitis C (HCV). By including oral antiviral drugs under National Health Insurance (NHI) coverage and successfully negotiating prices down to about one-tenth of their original cost, patients no longer need to sell property or take out loans to afford treatment. Pharmaceutical companies, in turn, gain market share through price reductions—creating a benchmark “win–win–win” model for new drug price negotiations.

Speaking of the advent of highly effective oral antivirals for hepatitis C, Kaohsiung Medical University President Ming-Lung Yu—who has devoted 30 years to HCV prevention and control—told CNA, “It was incredible; we finally saw the light at the end of the tunnel.” On the day the new drugs were included in NHI coverage, everyone shared one thought: “We must eliminate hepatitis C from my hometown.”

Before oral antivirals became available, standard HCV treatment consisted of ribavirin combined with injectable long-acting interferon. For patients whose symptoms were not obvious, the side effects were often harder to endure than hepatitis C itself—severe flu-like symptoms, depression, or chemotherapy-like drops in white blood cell counts and anemia. According to the Taiwan Liver Disease Prevention & Treatment Research Foundation, although NHI fully covered the combination therapy, only 10% to 15% of patients ever received it.

More than a decade ago, new drugs that could cure hepatitis C with minimal side effects came onto the market, yet they remained an unattainable “daydream” for patients. The Foundation’s CEO, Pei-Ming Yang, noted that a full course of treatment cost an average of NT$2.5–3 million—so expensive that even in the United States, few could afford it.

In Taiwan, only a handful of patients could self-pay at the time. Yang said many patients had to mortgage their homes and mobilize nearly all family resources just to seek treatment. The pressure on medical teams was also immense: efficacy was not 100%, with about 10% of patients potentially not responding. “Doctors often advised patients to wait—to not rush or risk their life savings,” he recalled.

In October 2016, then–Minister of Health and Welfare Tzou-Yen Lin began meeting with pharmaceutical companies. Making hepatitis C treatment accessible regardless of wealth required NHI inclusion, yet the high costs and large patient population posed a heavy burden even for the state. Acknowledging the high R&D costs, Lin nevertheless pushed decisively for price reductions.

Yang said Lin later admitted that when he first proposed slashing the price per course from over NT$2 million to NT$400,000, he had little confidence it would work.

Taiwan’s NHI negotiation prowess proved formidable. The final agreed price was NT$249,000—about one-tenth of the initial asking price—allowing hepatitis C drugs to be included in NHI coverage at a dramatically reduced cost.

Po-Chang Lee, then Director-General of the National Health Insurance Administration (NHIA), told CNA that during negotiations, other countries had begun adopting volume-based pricing; for example, South Korea had already lowered prices to around NT$250,000. Minister Lin told him at the time, “We cannot be more expensive than South Korea.” With more hepatitis C patients, Taiwan also had greater market potential.

Asked what he was most proud of in bringing hepatitis C drugs into NHI, Lee said it was about maintaining a calm, sincere approach. Negotiations with pharmaceutical companies are not about arguing or threatening, but about communicating in good faith.

“One kidney transplant patient left a deep impression on me,” Lee said. After transplantation, the patient’s kidney function improved, but hepatitis C continued to impair liver function. While Lee was still working clinically, he witnessed how the new drugs gave the patient a new lease on life—yet imposed an enormous financial burden.

With the successful introduction of new drugs into Taiwan, broader collaboration among the NHIA, healthcare providers, and pharmaceutical companies was only just beginning. To achieve a cost-effective “sweet price,” a certain patient volume—around 200,000 people—was required. This made it essential to identify all potential patients through active screening and robust reminder systems.

Lee explained that many hepatitis C patients have no obvious symptoms and may not visit gastroenterology clinics. The NHIA leveraged cloud-based data systems to design reminder alerts: when a physician in any specialty inserts a patient’s NHI card into the reader, an on-screen alert flags possible hepatitis C infection and the need for treatment.

Lee noted that if physicians have accurate information and offer just one extra reminder, treatment uptake can increase. The NHIA went further by allowing physicians of all specialties—not only specialists—to prescribe hepatitis C drugs under NHI. With the right strategies and sufficient resources, progress becomes achievable.

Notably, patient registry management and treatment quality monitoring mechanisms were also established. Once registered, patients receive support from case managers throughout treatment—addressing questions, monitoring efficacy, and providing guidance—strengthening collaboration between patients and providers.

According to Lee, this not only demonstrates Taiwan’s sincerity to pharmaceutical companies but also reshapes the doctor–patient relationship. Physicians are no longer mere passersby, and patients are no longer simply collecting prescriptions.

Physicians regularly monitor their hepatitis C patients on treatment, while case managers continue disease tracking. “Patients feel the care and responsibility of the medical team,” Lee said with a smile. “Naturally, treatment success rates rise.”

An anonymous medical professional revealed that beyond patient benefits, the NHI price negotiation for oral hepatitis C drugs represented a dual-win strategy for the NHIA and pharmaceutical companies. Initially, three companies launched new drugs. For the three-month regimen, one company cut prices while another did not; for the six-month regimen, competitive disadvantage led to a price cut as well.

The source said the largest-volume company that lowered prices earned NT$1.5 billion from a NT$2 billion hepatitis C drug budget, while the six-month regimen company earned the remainder. “As for the company unwilling to cut prices, the outcome was that its CEO was replaced.”

Lee believes the successful inclusion of hepatitis C drugs in NHI can serve as a model for future drug coverage decisions. Pharmaceutical companies seeking market expansion through NHI must strike a balance between cost and benefit, and between expert consensus and treatment guideline implementation.

He added that South Korea’s system is mature, with strong think tanks for health impact and cost-effectiveness assessments. They closely track international market dynamics; list prices and negotiated prices often differ, and success hinges on accurately grasping information.
(Editor: Ching-Fang Chen)

Original source:https://www.cna.com.tw/news/ahel/202512070062.aspx