Coverage and Purchase Options for Gan An Neng in Taiwan - Pharmacology

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How can I purchase health insurance and what are the benefits covered by the National Health Insurance?


My father previously had liver abnormalities and was advised by his doctor to take Danazol for treatment, which fortunately provided significant benefits.
However, at that time, Danazol was not covered by health insurance, so we had to purchase it out of pocket.
Recently, we were purchasing Danazol through a sales representative, but they suddenly stopped servicing that line, so we started looking for new purchasing channels.
While searching for new options, we inadvertently learned that Danazol has been included in the National Health Insurance coverage since October 2003.
However, until last month, why has the price of Danazol we were purchasing not significantly decreased? If it is covered by health insurance, shouldn't we no longer have to pay out of pocket?
I would like to ask: 1.
Where did we go wrong that prevented us from benefiting from Danazol's inclusion in health insurance coverage? 2.
Where can we purchase Danazol in Tainan City? Thank you!

alex, 20~29 year old female. Ask Date: 2005/06/29

Dr. Wu Huiling reply Pharmacology


Hello! According to the National Health Insurance reimbursement regulations, the following applies: (For purchasing information, please refer to the website: http://www.nhi.gov.tw/06inquire/query3_list.asp.)
10.7.3 Lamivudine (e.g., Zeffix 100mg) (92/10/1) is limited to the following chronic hepatitis B patients participating in the "National Health Insurance Enhanced Chronic Hepatitis B and C Treatment Pilot Program":
1.
Patients with HBsAg(+) for more than six months and HBeAg(+) for more than three months, with ALT levels greater than (or equal to) five times the upper limit of normal (ALT≧5X), or those who have developed liver decompensation (Prothrombin time ≧3 seconds or Bilirubin ≧3.0 mg/ml).
(93/2/1)
2.
Chronic hepatitis B virus carriers (HBsAg(+)) who develop hepatitis B after organ transplantation.
For liver transplant recipients, prophylactic use is permitted.
3.
Chronic hepatitis B virus carriers (HBsAg(+)) who develop hepatitis B after cancer chemotherapy may use the medication with the consent of a gastroenterology specialist.
(93/2/1)
4.
Patients with HBsAg(+) for more than six months and HBeAg(+) for more than three months, with ALT levels between two to five times the upper limit of normal (2X≦ALT<5X), confirmed positive for HBcAg via liver biopsy.
(Patients with hemophilia may be exempt from biopsy with the consent of a gastroenterology specialist.) (93/8/1)
5.
Patients with HBsAg(+) for more than six months and HBeAg(-) for more than three months, with ALT levels exceeding twice the upper limit of normal (ALT≧2X) on two or more occasions within six months (each separated by three months), confirmed positive for HBcAg via liver biopsy.
(Patients with hemophilia may be exempt from biopsy with the consent of a gastroenterology specialist.) (93/8/1)

Reply Date: 2005/06/29

More Info


Understanding the coverage and purchase options for Gan An Neng (干安能) in Taiwan can be quite complex, especially considering the changes in healthcare policies and the availability of medications. Let’s break down your questions to provide clarity.

1. Understanding Coverage and Potential Oversights:
It seems that your father has been using Gan An Neng for liver abnormalities, and while it has been effective, the confusion regarding its coverage under Taiwan's National Health Insurance (NHI) system is understandable. As of October 2003, Gan An Neng was indeed included in the NHI coverage, which means that eligible patients should not have to pay out-of-pocket for this medication. However, there are a few reasons why you might not have benefited from this coverage:
- Prescription Requirements: Ensure that the medication is prescribed by a healthcare provider who is familiar with the NHI regulations. Sometimes, if the prescription is not properly documented or if the doctor does not specify the need for the medication, it may not be covered.


- Pharmacy Participation: Not all pharmacies may participate in the NHI program for every medication. It’s essential to purchase Gan An Neng from a pharmacy that is authorized to dispense NHI-covered medications. If you were buying it from a representative or a non-participating pharmacy, that could explain the lack of coverage.


- Documentation and Claims: Sometimes, the pharmacy may require specific documentation or may need to submit a claim to the NHI on your behalf. If this process is not followed correctly, you may end up paying out-of-pocket.

2. Where to Purchase Gan An Neng in Tainan:
In Tainan, you can find Gan An Neng at various pharmacies, especially those that are part of larger chains or those that are known to participate in the NHI program. Here are a few suggestions:
- Local Hospitals and Clinics: Often, hospitals have their own pharmacies where you can purchase medications, and they are more likely to be familiar with NHI coverage.


- Chain Pharmacies: Look for well-known pharmacy chains in Taiwan, such as Watsons or Cosmed, as they often have a wider selection of medications and are more likely to accept NHI coverage.


- Community Pharmacies: Smaller, local pharmacies may also carry Gan An Neng, but it’s important to confirm that they accept NHI coverage. You can call ahead to check.

In conclusion, to ensure that you can take advantage of the NHI coverage for Gan An Neng, it’s crucial to verify that you are obtaining the medication through the correct channels. Consulting with your father’s healthcare provider can also help clarify any specific requirements or documentation needed to ensure coverage. If you continue to face challenges, consider reaching out to the NHI office for assistance or guidance on how to navigate the system effectively.

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