“Health right is a human right”

Wang Ya Hsin, Chief Secretary of Psoriasis Association Taiwan (PAT).

A true David vs. Goliath story unfolded in Taiwan, where our member organization – Psoriasis Association Taiwan (PAT) stood up against a government proposal that would have limited access to care for people living with psoriasis. By mobilizing patients, gathering evidence, and engaging policymakers across party lines, they helped reverse the decision. We talked to Wang Ya Hsin, Chief Secretary of PAT, who shared the success story of how a grassroots movement drove real policy change.

Can you explain how Taiwan’s national health insurance system works and how it affects access to psoriasis treatment?

Taiwan's national health insurance system operates as a single-payer system with a total budget model. This means that there is one main insurance payer – the government. Instead of multiple insurance companies, the national health insurance program collects money (through taxes/premiums) and pays for most healthcare services for everyone. Therefore, the government strictly controls the budget, and each year in September, the total budget for the following year is determined by the National Health Insurance Committee.

Under this system, reimbursement criteria for psoriasis biologic therapies are as follows: if patients have undergone conventional systemic oral treatment and phototherapy, and their psoriasis area and severity index (PASI) remains ≥10, physicians may apply for biologic therapy on their behalf. Once approved, and if effective, treatment can be used for up to two years. After this period, treatment must be temporarily discontinued, meaning patients must stop biologic therapy. Treatment can only be restarted once the disease relapses and involves at least 50% of the body surface area.

How does this affect patients when treatment is stopped after two years?

This policy has significant impacts. Some patients experience reduced effectiveness when restarting the same biologic, meaning they may need to switch to another treatment. Others face worsening physical and mental health after relapse, leading to interruptions in employment or education. This not only affects quality of life but can also undermine patients’ confidence in treatment.

What did you do to change this decision?

I would like to clarify that this took place in June last year. The government proposed to extend biologic therapy from two to four years and, at the same time, to raise the treatment response requirement from PASI 50 to PASI 75.

At first, we thought extending treatment duration was beneficial. However, increasing the response rate to PASI 75 – although aligned with international standards – posed major challenges due to the mandatory discontinuation policy. In reality, many patients struggle to achieve PASI 75 after re-treatment. It was estimated that nearly 3,000 patients would be significantly affected. They may not be able to apply for biological agent treatment covered by health insurance afterwards, if this policy change would have been approved.

At that time, the proposal was about to enter expert committee review, leaving very limited time for any reaction. Our association, Psoriasis Association Taiwan (PAT), quickly distributed a patient questionnaire and gathered responses from over 300 members. We compiled this with the evidence from the medical literature, and, together with the patient real stories, made a formal petition and submitted it to legislators across political parties and to the Minister of Health and Welfare.

With support from multiple stakeholders, the proposal was halted, meaning – they had to stop this proposal.

That sounds like a major effort – what did it involve?

Yes, we worked closely with physicians, public health specialists, patients, patient organizations, and legislators. We also engaged the main three political parties, presenting evidence, patient surveys, and patient stories to advocate for change.

What are your next steps?

We want to expand coverage and eliminate the mandatory discontinuation requirement. Patients should not be forced to stop treatment. We need continuous, comprehensive care, no mandatory discontinuation. We believe mandatory discontinuation is a human rights issue – health right is a human right. We will continue monitoring the situation and engaging with stakeholders, including government and legislators.

Has a final decision been made on treatment duration?

At this stage, the criteria remain unchanged. The proposed tightening – from PASI 50 to PASI 75 – was not implemented, which means we avoided a worse situation. But our goal is to expand access further so more patients can receive care.

Are you satisfied with the progress so far?

We worked very hard – conducting surveys and engaging many stakeholders. But we want to do more. Our goal is to further expand coverage so more patients can receive care they need.

What do you think has to be done to protect the rights and improve wellbeing of people with psoriasis in Taiwan? 

I believe there are still many important initiatives that need to be continuously advanced. These include eliminating the “mandatory discontinuation treatment ” policy for biologic therapies to prevent repeated relapses that may lead to disease worsening and reduced treatment effectiveness. 

In addition, promoting multidisciplinary team (MDT) care would enable patients to receive more comprehensive and coordinated support. Ongoing public health education is also essential – targeting patients, their families, and the general public – to reinforce the understanding that psoriasis is not contagious. Furthermore, fostering psoriasis-friendly workplaces, such as encouraging employers to provide flexible working arrangements and support for medical visits, is equally important. Overall, these efforts should be advanced collaboratively across the medical, educational, and policy sectors.