Venclexta Coverage and Costs for Cancer Patients in Taiwan

Wanke medication

Dr.
Chen! I have undergone chemotherapy abroad and completed two autologous stem cell transplants.
I am currently receiving injections of Venclexta (2.4 mg every two weeks) and taking Revlimid (10 mg) as part of my follow-up treatment.
I plan to return to Taiwan by the end of 2015 and would like to know if Taiwan's National Health Insurance covers the medications: Venclexta injection, or will I need to purchase them out of pocket? How long does the application process take, and what are the costs? Additionally, I am currently taking Valacyclovir (500 mg) and Tenofovir (300 mg) for hepatitis B, which I can obtain locally.
Thank you for your response.

Mrs. Chen, 60~69 year old female. Ask Date: 2015/06/28

Dr. Chen Sirong reply Oncology

Mrs.
Chen / 66 / 11.
You have not provided medical information, so I cannot determine the eligibility for National Health Insurance coverage.
Below are the National Health Insurance coverage regulations:
9.28.
Bortezomib (e.g., Velcade for Injection): (96/6/1, 98/2/1, 99/3/1, 99/9/1, 100/10/1, 101/6/1) Schedule 9-3 is limited to:
1.
Used in combination with other cancer treatment drugs for patients with multiple myeloma:
(99/3/1, 100/10/1, 101/6/1)
(1) A maximum of 8 treatment cycles per person (99/9/1).
(2) Must be used after prior application, with each application covering 4 treatment cycles (101/6/1).
(3) After 4 treatment cycles, it must be confirmed that the paraprotein (M-protein) has not increased (indicating response or stable status), or for some non-secretory type MM patients, the efficacy is based on the ratio of plasma cells in the bone marrow examination, before applying for the subsequent 4 treatment cycles (101/6/1).
(4) If the patient meets the efficacy criteria in the first 4 treatment cycles as stated in (3), the subsequent 4 treatment cycles can be reserved and re-applied for use upon disease relapse (101/6/1).
2.
Patients with Mantle Cell Lymphoma (MCL) who have relapsed or been ineffective after receiving at least one treatment:
(98/2/1)
(1) A maximum of 8 treatment cycles per person (99/9/1).
(2) Maximum daily dose of 1.5 mg/m²/day; administered on days 1, 4, 8, and 11 of each cycle.
(3) After 4 treatment cycles, re-evaluation is required; if effective, an additional 4 treatment cycles may be used.
(4) Must be used after prior review and approval.
2.
The self-pay price for one treatment cycle is approximately 160,000.
The application process takes about 2 weeks.
You may also consult Dr.
Chen Jun-Yi from the Department of Medical Oncology at http://cancerfree.medicalmap.tw/.
Thank you for your letter.
Taoyuan Medical Center, Chen Si-Rong.

Reply Date: 2015/06/28

More Info

Understanding the coverage and costs for cancer treatments, particularly Venclexta (venetoclax), in Taiwan involves several important considerations, especially for patients who have undergone extensive treatments like chemotherapy and stem cell transplants.
Firstly, it's essential to know that Venclexta is primarily used for treating certain types of blood cancers, including chronic lymphocytic leukemia (CLL) and acute myeloid leukemia (AML). In Taiwan, the National Health Insurance (NHI) system provides coverage for many cancer treatments, but the eligibility for specific medications like Venclexta can depend on various factors, including the patient's diagnosis, treatment history, and the prescribing physician's recommendations.

For patients returning to Taiwan after receiving treatment abroad, the process typically begins with a consultation with a hematologist or oncologist who specializes in blood cancers. They will evaluate the patient's current condition, review the treatment history, and determine whether Venclexta is appropriate for the patient's ongoing treatment plan. If the physician deems Venclexta necessary, they will submit an application to the NHI for coverage. This application usually includes the patient's medical records, pathology reports, and any relevant imaging studies.

The approval process for NHI coverage can vary in duration, but it generally takes a few weeks. During this time, the healthcare provider may need to provide additional information or documentation to support the application. Once approved, the patient can receive Venclexta at a significantly reduced cost compared to out-of-pocket expenses.

Regarding the costs, if Venclexta is covered by NHI, the patient will only need to pay a co-payment, which is typically a fraction of the total cost of the medication. However, if the application for NHI coverage is denied or if the patient does not meet the criteria for coverage, they will need to purchase Venclexta out-of-pocket. The price of Venclexta can be quite high, often exceeding NT$100,000 per month, depending on the prescribed dosage. Therefore, understanding the financial implications of treatment is crucial for patients and their families.

In addition to Venclexta, you mentioned ongoing treatments with other medications such as Valacyclovir and Tenofovir for hepatitis B. These medications may also be covered under the NHI, but it is advisable to check with your healthcare provider regarding their specific coverage and any necessary documentation for continued access to these medications.

It's also worth noting that the healthcare system in Taiwan is known for its efficiency and high standards, which can provide peace of mind for patients returning for treatment. The collaboration between healthcare providers and patients is vital in navigating the complexities of treatment options and insurance coverage.

In summary, for patients like yourself returning to Taiwan for cancer treatment, it is essential to consult with a qualified oncologist to assess the appropriateness of Venclexta and initiate the NHI coverage application process. Understanding the costs involved, both with and without insurance coverage, will help in planning for your ongoing treatment and ensuring access to necessary medications.

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