Next-Generation Gene Sequencing Tests Are Officially Included in Taiwan’s National Health Insurance Benefits Starting from May 1, 2024!

As mentioned in our “ Overview of Key Biotech and Pharmaceutical Issues in Taiwan for 2023 ,” next-generation gene sequencing (referred to as “NGS”) tests can quickly detect a large number of genetic mutations.  This capability helps clinicians rapidly select appropriate targeted therapies for cancers, achieving precise treatment goals.  Since May 1, 2024, the Ministry of Health and Welfare (referred to as “MOHW”) has officially included relatively expensive NGS in health insurance benefits to reduce patients’ financial burden.  A brief description of the covered cancer types, payment methods, and testing hospital qualifications ^[1]  is as follows:

1. Testing Cancer Types:

It includes 14 major categories of solid tumors, such as non-small cell lung cancer, triple-negative breast cancer, pancreatic cancer, and thyroid cancer, etc., as well as 5 major categories of hematological tumors, such as acute myeloid leukemia and higher-risk myelodysplastic syndromes, etc.

2. Payment Methods:

Each individual is entitled to one covered NGS test for each type of cancer in their lifetime and may undergo additional testing if a second cancer arises (excluding cancer metastasis).  The payment method varies depending on variations in testing methods, the number of genetic sites, and patient needs. National Health Insurance offers a set amount of coverage, with patients accountable for any price difference.

3. Testing Hospital Qualifications:

Hospitals conducting NGS tests must submit an application to the National Health Insurance Administration in advance and meet the following three conditions:

(1) Limited to “hospitals above the district level” or “Cancer care quality accredited hospitals”;
(2) Must be a medical institution listed in the Laboratory Developed Tests (LDTs) implementation plan approved by the MOHW; and
(3) The hospital must establish its own or jointly form a Molecular Tumor Board (MTB) across hospitals.

[1]  Ministry of Health and Welfare, “From May 1, the National Health Insurance will include coverage for Next Generation Gene Sequencing (NGS) tests for solid cancers and blood cancers, benefiting over 20,000 cancer patients,” April 19, 2024, https://www.mohw.gov.tw/cp-16-78416-1.html (last visited June 11, 2024).