Over the past three decades, Taiwan’s elderly population – defined as individuals aged 65 and older – has expanded by a staggering 152 percent. This demographic shift has introduced complex public health challenges, most notably a sharp rise in cancer incidence. “The epidemiological picture is quite sobering,” notes John Chang, CEO of the Formosa Cancer Foundation, who points out that the annual caseload now stands at 331.3 per 100,000 people, or roughly 138,000 new diagnoses each year. “Taiwan has long confronted this crisis, with cancer ranking as the nation’s leading cause of death for 43 consecutive years. This is driven by increased longevity alongside lifestyle factors like Westernised dietary patterns,” he explains.

 

Consequently, successive administrations have worked to address the crisis. The 2003 Cancer Control Act first standardised Taiwan’s nationwide prevention and treatment network. A subsequent 2023 amendment shifted the island’s strategy from viewing cancer as an individual medical issue to addressing it through an integrated, ‘whole-of-society’ public health framework. Incumbent President William Lai’s 2025 initiative represents the most ambitious plan to date: under his ‘Healthy Taiwan’ vision, the government aims to reduce the nation’s age-standardised cancer mortality rate by one-third before the end of the decade.

 

USD 310 Million Cancer Drug Fund

To help realise that grand ambition, his administration has introduced a brand-new cancer drug financing mechanism to act as a provisional payment system. The intention being to bypass traditional lengthy and bureaucratic reimbursement processes and instead provide cancer patients with swift and affordable access to breakthrough drugs, cell therapies, and frontline immunotherapies.

“Our government has committed to building a NTD 10 billion (USD 310 million) Cancer Drug Fund (CDF), with NTD 5 billion (USD 155 million) allocated in 2025 and another NTD 5 billion planned for 2026 under the current budget framework. This managed entry contracting mechanism allows conditional reimbursement for therapies with promising Phase II data,” confirms Chung-Liang Shih, Minister of Health and Welfare.

The way it works is that temporary coverage is granted with defined reassessment periods and real-world evidence is collected over two to three years to inform final reimbursement decisions. “The benefit of this approach is that it accelerates patient access while simultaneously managing financial risk in a disciplined and transparent manner,” argues Shih.

Many industry insiders agree. “We think the new fund is a genuinely impressive initiative that is going to make a real difference for patients. After all, this involves 10 billion Taiwanese dollars of supplementary funding above and beyond existing NHI budgets,” opines Vincent Tong, former managing director at the American biopharma, MSD.

According to Tong, the benefits are already starting to show. “Our immunotherapy-based cancer treatment entered the Fund in June, securing reimbursement for first-line lung cancer, first-line triple-negative breast cancer, and first-line colorectal cancer which meant benefiting 3,400 additional patients annually who were hitherto ineligible. Such applications would have been frankly impossible under the previous funding regime,” he reveals.

Jayashri Kulkarni, managing director at Johnson & Johnson concurs. “Within its first year of operations, approximately 36 therapies received reimbursement approvals or extensions through the Fund, delivering substantial benefits to patients and their families in both health outcomes and financial relief. Conditional listing is meanwhile facilitating market entry for new launches so, all in all, the new arrangement is having a very tangible and positive impact,” she posits.

Some drugmakers, though, fret about the ad hoc, temporal nature of the Fund and would prefer to see the newly allocated financial firepower brought under the umbrella of regular NHI health expenditure. They are therefore calling for it to be codified into law by the Legislative Yuan to transform it from a provisional cash injection into a permanent institution.

“We of course appreciate the government’s commitment to creating this mechanism as it acknowledges the urgency of cancer care. However, from an industry perspective, it’s too early to judge either the long-term performance or sufficiency,” reasons Alexis Lin, general manager at Takeda. “To make an accurate assessment, we’ll need to closely watch two indicators over the coming quarters: utilisation rates and the sustainability of funding once the programme transitions back into general budgets,” she asserts.

Nick Wang, general manager of another Japanese biopharma, Daiichi Sankyo, is even more forthright. “Our worry is that after two years, uncertainty returns. Once patients are on treatment, it is frankly not realistic to withdraw therapy simply because long-term pricing cannot be sustained. To date, we have not yet seen many strong examples of products exiting the Fund with stable, long-term reimbursement in place,” he warns.

“For the fund to remain sustainable, the underlying structure of reimbursement should evolve,” believes Diana Liu, general manager at Roche Pharma. She notes that a significant proportion of NHI expenditure still goes towards mature and off-patent medicines and advocates that the increased investment should be supported by a rebalancing that rewards genuine innovation while allowing deeper price erosion for older therapies. “This would enable the system to channel resources towards bringing rapid patient access to new treatments that truly transform outcomes,” she contends.

Lian-Yu Chen, director general of the National Health Insurance (NHI) Administration, however, is quick to assuage any such concerns. “Claims that the Fund is merely temporary misunderstand its underlying policy rationale,” she insists.

Moreover, she rejects any assertions of unsustainability. “Cross-party legislative support remains strong, yet formally embedding the fund within National Health Insurance legislation would trigger complex congressional negotiations, often expanding into demands for parallel funds for other therapeutic areas, delaying action for years. Public funding, grounded in the President’s mandate, avoids these obstacles while delivering timely benefits to patients and families – an approach that may appear unconventional internationally but is the most effective within Taiwan’s legislative context,” argues Chen.

Not only does she reassure stakeholders that the state will walk the talk by ensuring the longevity of the Fund, but also says there are detailed plans in place to make additional funding available when required. “Because Taiwan’s population is ageing and the plan is successfully keeping cancer patients alive for longer, healthcare costs in this area will only continue to increase. We are aware of this and are prepared to actively inject supplementary emergency budgets to guarantee the Fund remains fully funded as it moves toward its 2030 target,” she confirms.

 

Enhanced Screening & Diagnostics

Meanwhile, the State has heavily boosted its national screening budget from NTD 2 billion (USD 64 million) to NTD 6.8 billion (USD 220 million) to cover five major cancers across younger and broader age demographics. “This more than 200 percent increase to the screening budget can be a real game changer and should facilitate a stage-shift in catching cancers earlier when they are still curable,” predicts the Formosa Foundation’s John Chang, who applauds the wisdom of placing greater emphasis on prevention and early-stage diagnostics.

“Already such an approach has started to bear fruit by enabling the detection of approximately 60,000 precancerous lesions and 12,000 cancer cases, benefiting more than 70,000 individuals,” he claims.

Sophia Chao, general manager of Roche Diagnostics agrees noting that the administration has been promoting an ‘end-to-end’ approach to countering cancer which should help ensure that screening leads to diagnosis, staging, treatment, and preventive interventions for precancerous disease. “Through this powerful integration, Taiwan will not only significantly enhance the health prospects of its population and optimise overall patient care pathways but simultaneously rein in costs and contribute to the long-term sustainability of the public health system through swift and effective treatment plans,” she forecasts.

Moreover, the island, in its zeal to improve early cancer screening, has won international plaudits for its ongoing role in reining in lung cancer incidence. “Lung cancer in Eastern Asia has long presented an epidemiological anomaly compared to Western countries, with a large proportion of afflicted patients – especially women – comprising lifelong non-smokers who had developed EGFR gene mutations. This meant that traditional smoking cessation campaigns, which are common in the West, were never going to be sufficient to tackle the problem,” explains Professor Pan Chyr Yang of Academia Sinica.

Instead, he successfully lobbied the Taiwanese state to pioneer national Low-Dose Computed Tomography (LDCT) screenings specifically for non-smokers with a genetic family history, the results of which have been dramatic. “To date, we have screened over 200,000 individuals across more than 200 participating hospitals nationwide achieving an 85.9 percent early-stage detection rate – an excellent result with the programme has become internationally recognised as an exemplary model that has radically improved survival prospects,” he enthuses.

 

Towards Precision Medicine

Building on the successes in lung cancer screening, the NHI has now started reimbursing Next-Generation Sequencing (NGS) genetic testing across 14 solid tumour categories and five haematological malignancies with more than 20,000 patients expected to benefit annually.

This, in turn, has placed cancer squarely on the frontline of Taiwan’s efforts to transition towards personalised medicine. “In my opinion, the reimbursement of NGS in May 2024 was a watershed moment. Though still limited in scope, it signalled a clear policy move toward earlier molecular insights for cancer patients,” affirms Roche’s Sophia Chao.

“The more the NHI is able to cover NGS genetic testing, the more it will allow oncologists to pinpoint exact tumour mutations, mapping out personalised targeted therapies and immunotherapies while the testing data can also be fed into a national biobank to fuel local biomedical research,” she explains.

For this reason, some stakeholders are lobbying for the State to go even further and start offering comprehensive and standardised genetic testing for cancer. “Though we have as a nation undeniably witnessed great progress, there remain significant gaps that need to be closed. Presently, coverage is not uniform across all tumour types; with some receiving full reimbursement, while others are limited to specific gene panels,” declares Jerry Cheng, general manager for Taiwan, Hong Kong, and Macau at Illumina who points out that, for melanoma, the prevailing policy covers only BRAF gene testing rather than a complete NGS panel.

“The imperative is clear: we require whole-panel NGS testing and distinct reimbursement channels for the corresponding targeted therapies once actionable mutations are identified. Without the financial mechanism to access the drug, the diagnostic insight remains academically interesting, but is clinically impotent for the patient”, Cheng insists.

“Only when genomics achieves full healthcare system integration, will healthcare providers be able to deliver tailored, optimal treatment pathways by ensuring cancer patients get the right drug within their critical therapeutic window. Without it, many cancer treatment regimes risk remaining suboptimal and payers will be unable to unlock the savings generated from eschewing unnecessary interventions,” he reasons.

Meanwhile other stakeholders are pushing for wider state application and financing of Minimal Residual Disease (MRD) detection using ctDNA to detect cancer cells after treatment to tailor how long or intense follow-up therapy should be. “I propose we invest heavily in MRD detection for solid tumours as this would allow the health system to tailor treatment duration and intensity precisely and scientifically,” counsels the Formosa Foundation’s John Chang.

That said, most industry insiders still consider Taiwan a genuine trailblazer in the global battle against cancer. “Taiwan’s healthcare sector stands apart for the approachability, responsiveness, and enlightenment of its decision-makers when grappling against this great scourge of our time,” believes Johnson & Johnson’s Kulkarni. “Not only does this instil much confidence within industry, but it supports the feasibility of truly ambitious and pioneering initiatives that can make a real difference both at the local and global levels,” she concludes.