The public is once more debating whether the National Health Insurance (NHI) should cover the expenses of pharmacy-only medicine. Benefit payments provided by the NHI for pharmacy-only drugs last year totaled NT$2 billion (US$65.2 million), Ministry of Health and Welfare figures show. The amount is based on a population of about 18.5 million people. If each person was charged NT$200 for the minimum medical service fee, the amount of diagnostic fees would be about NT$3.7 billion, medical and pharmaceutical expenses about NT$1 billion, and self-bearing medical fees about NT$2.7 billion. Altogether, the NHI provided about NT$9.4 billion last year. If the amount could be reduced, the nation would be able to introduce more up-to-date drugs and implement other insurance plans.
Drugs are generally classified into three categories: drugs with higher risk, stronger efficacy and greater side effects are designated as prescription drugs; milder ones are classified as pharmacy-only drugs; and the rest are over-the-counter drugs.
Some say that if the NHI stops covering pharmacy-only medicine, it would infringe on people’s right to pharmaceutical services and the probability of treatment delays would increase.
That is an arbitrary judgement, as all pharmacy-only drugs must go through three stages of clinical trials; their safety is guaranteed by every country.
Moreover, pharmacists in local drugstores remind their customers to see a doctor immediately if the medicine does not work well. This is how levels of healthcare and responsible self-medication are practiced, and is a standard process in most advanced countries.
However, the nation should consider public opinion before changing the NHI policy. To avoid negative reactions, the NHI should modify insurance plans incrementally.
Furthermore, rather than referring to medical specialty and number of patients as the major criteria, other factors must be taken into account, including the drugs’ safety, indications, timing of use, side effects and clinical necessity. For pharmacy-only medicine that would continue to be covered by the NHI, the government should also help pharmaceutical companies apply for certificates.
Carbomix, for example, is classified as a pharmacy-only drug due to its relative safety, yet it is also used as an emergency treatment. Therefore, Carbomix must be certified as both a prescription and pharmacy-only drug, so that people can purchase it at pharmacies, while its clinical use is covered by the NHI.
The NHI covers 841 items classified as pharmacy-only drugs. The government should remove the outdated ones from the list. Officials should consult academics and medical experts to review those items based on empirical data and accurate statistics.
Meanwhile, as pediatricians have pointed out, drugs for children under the age of 12 should be prescribed by doctors. The issue must be further discussed by officials and experts. If pharmacy-only drugs are covered by the NHI, would that make parents more willing to take their children to a doctor?
Each year, a budget is allocated to the NHI. Taiwan should not go against the international trend by allowing more benefit payments for pharmacy-only drugs. For now, reform should be implemented gradually, but ultimately, Taiwan should follow the example of advanced countries, where pharmacy-only drugs are paid at one’s own expense.
Huang Jin-shun is national policy adviser to the president and president of the Federation of Taiwan Pharmacists’ Associations.
Translated by Emma Liu
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