臺灣跨國藥廠新藥引進與定價策略

Abstract

台灣醫療在 1995 年開始實施全民健保下，民眾就醫權益在健保下人人平等，而醫藥產業也在此時銷售大幅成長，台灣藥廠醫藥銷售成長跟不上健保連年快速的增長，因此反映在台灣健保支出之中，跨國性藥廠的銷售額佔了健保成長較高的百分比，也由此可知新藥納入健保給付對於銷售成長的重要性。新藥研發上市是否能第一時間進入台灣市場，最主要因素為台灣每年健保預算的編列與健保價格的審核機制，而跨國性藥廠新藥進入台灣市場，新藥價格會經歷三個階段的價格訂定，階段一納入健保給付、階段二進入各醫療院所通路、階段三每年健保價格調降，透過全球目前醫藥市場環境，以及各跨國性藥廠投入多少研發經費，可以知道各藥廠未來將可能有多少新藥上市。另外從新藥上市專利保護對於藥品價格的重要性，在帶到台灣目前醫藥環境，台灣藥廠沒有研發新藥的能力，因此只能透過研發學名藥搶奪專利過期的原廠藥市場。但在台灣健保支出連年虧損的情況下，健保不願開源增加民眾保費收入，只好節流每年大幅下調跨國性藥廠藥品健保給付價格，讓新藥研發上市後，跨國性藥廠難以將新藥評估引進台灣或是原廠藥品快速退出台灣市場，不僅讓台灣民眾沒有更新藥物可以治療疾病，也連同台灣藥廠藥製造學名藥的品項越來越少。導致台灣醫療產業像骨牌效應般，跨國性藥上任職或是台灣藥廠任職的從業人員接受裁員與薪資退步，也影響到一線醫療人員在照顧病患上更加困 難，即使台灣的醫護人員相當優秀，但在新藥無法引進，現有原廠藥品品項受不了健保連年調降而退出市場，即使台灣的醫護人員在優秀，臨床上少了武器，讓醫療人員束手無策，最後受害的還是病患，因此與新加坡目前健康保險做比較，選擇新加坡原因為其人口結構與台灣相似，且新加坡藥廠也沒有研發新藥的能力，但新加坡卻能透過與台灣不一樣的健保制度與政府對跨國性大藥廠的稅制放寬，讓新加坡原廠藥新藥能以更好的價格銷售，也能讓新加坡學名藥廠有更多藥品可以研發，因此台灣能否透過學習新加坡或是其他國家的醫療體制，讓台灣醫療環境、醫藥產業、民眾達到三贏，是未來的願景與目標。

Taiwan's healthcare system implemented universal health insurance in 1995,ensuring equal access to medical care for all citizens. As a result,the pharmaceutical industry experienced significant sales growth. However, the sales growth of Taiwan's pharmaceutical companies could not keep up with the rapid expansion of the health insurance system. This is reflected in the healthcare expenditure,where the sales of multinational pharmaceutical companies account for a higher percentage of the overall growth. This highlights the importance of including new drugs in the health insurance coverage to drive sales growth. The primary factors affecting the timely entry of new drugs into the Taiwanese market are the annual budget allocation for health insurance and the pricing review mechanism.When multinational pharmaceutical companies introduce new drugs to the Taiwanese market,the pricing undergoes three stages: Stage 1 involves inclusion in health insurance coverage,Stage 2 involves access through various medical institutions,and Stage 3 entails annual price reductions within health insurance. By examining the current global pharmaceutical market environment and the amount of research and development investment by multinational pharmaceutical companies, we can estimate the number of new drugs that each company is likely to introduce in the future. Furthermore,the importance of patent protection for drug pricing is crucial. Considering Taiwan's current pharmaceutical environment,domestic pharmaceutical companies lack the capability to develop new drugs.Therefore,they can only compete in the market by developing generic drugs after the patent of the original drugs has expired.However,due to the continuous deficit in Taiwan's health insurance expenditure,the insurance system is reluctant to increase premiums,leading to significant reductions in health insurance reimbursements for multinational pharmaceutical companies each year.This makes it difficult for them to introduce new drugs or maintain the presence of original drugs in the Taiwanese market. As a result,not only do Taiwanese patients lack access to updated medications, but the range of generic drugs manufactured by domestic pharmaceutical companies is also decreasing. This has a domino effect on the Taiwanese healthcare industry, resulting in layoffs and salary reductions for employees working in multinational pharmaceutical companies or domestic pharmaceutical companies. It also makes it more challenging for frontline healthcare workers to provide adequate care to patients. Despite the excellence of Taiwan's healthcare professionals, the inability to introduce new drugs and the withdrawal of existing original drugs from the market due to continuous reductions in health insurance reimbursement render healthcare workers helpless. Ultimately, patients are the ones who suffer. Therefore,comparing Taiwan's current healthcare insurance system with that of Singapore,I chose Singapore because its population structure is similar to Taiwan's, and Singaporean pharmaceutical companies also lack the ability to develop new drugs.However,Singapore has a different health insurance system and the government has relaxed the tax regulations for multinational pharmaceutical companies. This allows Singaporean original drugs to be sold at better prices and enables Singaporean generic drug companies to develop more medications. Thus, Taiwan's future vision and goal should involve learning from Singapore or other countries' healthcare systems to achieve a win-win situation for Taiwan's healthcare environment,pharmaceutical industry, and its people.