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\"end\": 900.046, \"score\": 0.921}, {\"word\": \"謝\"}, {\"word\": \"謝\"}, {\"word\": \"王\", \"start\": 900.046, \"end\": 900.446, \"score\": 0.95}, {\"word\": \"振\", \"start\": 900.446, \"end\": 900.607, \"score\": 0.879}, {\"word\": \"旭\", \"start\": 900.607, \"end\": 900.987, \"score\": 0.899}, {\"word\": \"委\", \"start\": 900.987, \"end\": 901.207, \"score\": 0.897}, {\"word\": \"員\"}, {\"word\": \"謝\"}, {\"word\": \"謝\"}, {\"word\": \"部\", \"start\": 901.207, \"end\": 901.387, \"score\": 0.889}, {\"word\": \"長\"}, {\"word\": \"署\", \"start\": 901.387, \"end\": 901.407, \"score\": 0.0}, {\"word\": \"長\"}], \"language\": \"zh\"}","srt":"1\n00:00:07,557 --> 00:00:10,547\n好非常感謝主席我們還是請邱部長\n\n2\n00:00:17,724 --> 00:00:37,410\n菁部長好今天的這個主題我想經過這麼多委員的槌尋剛剛也做了非常完整的說明不過還是有三個問題再跟部長還有跟其他同仁就教一下第一個就是川普藥價最惠國政策對我國藥品價格及供應的衝擊因應的對策\n\n3\n00:00:40,331 --> 00:01:06,028\n我們第二個部分就是要如何提升我國學民藥的自給率第三個就是美國藥品關稅對我國原料要進出口的影響基本上就是這三個問題那有關於這個川普要加最後一國政策的衝擊我想大家都非常清楚差不多兩月半前這個川普總統就公開的發函\n\n4\n00:01:07,409 --> 00:01:36,838\n他希望全球17家國際的大藥廠不是只有美國的藥廠而已要大幅降低美國處方藥的價格因為我們都了解很多新藥產出的時候都是從美國開始美國FDA就會通過相關的私營證然後開始做一些藥物的給付在抗癌藥這部分其他的一些新的\n\n5\n00:01:37,358 --> 00:02:03,286\n不管是新機制或者是一些創新的藥品很多是從美國這邊研發出來的所以他就針對於這個藥價的部分依照經驗還有實際的狀況其實美國的藥價普遍都會比其他國家相對高一點所以他當然川普就覺得這樣很不爽以外為什麼美國人用藥的價錢會比其他國家的人\n\n6\n00:02:03,866 --> 00:02:25,913\n還要高所以他就特別希望能夠有好的方式有適當的機制來做這樣的處理所以他要求要17個大藥廠敦促這些大藥廠要降價並且將適當的機制以超額收入能夠回饋給美國的政府當然還有包括美國的人民\n\n7\n00:02:26,693 --> 00:02:43,220\n所以他要求在9月29號之前他必須要有相關的這個做出承諾要求這個17家的大藥廠能夠配合他的要求如果不配合的話那就看著辦\n\n8\n00:02:44,180 --> 00:03:06,629\n這個就是我們為什麼今天要花很多的時間精神來討論一下如果這些大藥廠真的針對於我們看到下一張的內容有施大要求他們如果都真的配合這樣的要求的話那對台灣用藥的權益或者是在費用上會造成什麼樣的衝擊跟影響\n\n9\n00:03:07,629 --> 00:03:28,231\n第一個就是它的世代要求之一要拓展最惠國定價到這個醫療補助裡面第二個是要保證新上市的藥品的最惠國定價就是說反正不管怎麼樣我們美國的藥品不可能要比其他國家的這些用藥還要來得高\n\n10\n00:03:28,972 --> 00:03:46,100\n就是他做標準就對了他如果比較低別人不能比他高就是說他要拿到的是最低的藥價讓他那個民眾在用藥上的權益是可以同步的去使用到藥物然後又是全球最低價\n\n11\n00:03:47,340 --> 00:04:09,847\n第三個就是海外增加的收入要還給美國的患者跟納稅人第四個就是要提供中國的價格的直接採購這個是他具體的要求我們往下看就知道說那為什麼美國要把優惠供給我們台灣為什麼會影響到譬如說我們的優惠要變多貴這到底是什麼邏輯或是什麼理由\n\n12\n00:04:10,527 --> 00:04:33,007\n那這邊我們看得出來剛剛所提到的因為台灣長期以來是以相對的低價來不管是從美國或者是從其他的地方購入的這個藥品都會比原地可能還要低一點那如果美國政府要求要這個藥廠要壓低價格的話那台灣我們本來是相對於其他\n\n13\n00:04:34,007 --> 00:04:56,044\n國際的這個用藥價格相對比較低的時候那我們變成是會被要求要漲價的對象就其他17家或其他的藥廠可能就會要求台灣的這個藥價不能夠這麼低這個是我們可以理解的地方所以莊黃仁老師就指出說因為台灣長期以來用低價進入購入這個美國藥品\n\n14\n00:04:57,845 --> 00:05:12,542\n所以從川普的立場來看這個也很自然啦那吃幾吃那麼久啊所以感覺他這次身為美國總統他要勇敢的或者是要有魄力的站出來要把這個事情能夠做一個徹底的解決\n\n15\n00:05:13,403 --> 00:05:29,768\n所以當他發現說美國藥廠在海外市場賣得比較便宜回到國內就是說他美國自己發明的藥下去其他的國家電動鼻涕美國國家給所以他一定要把這個筆賬要討回來\n\n16\n00:05:31,748 --> 00:05:50,544\n所以張老師就表示說如果藥廠重新來訂調整全球的價格的時候台灣有給可能要面臨兩到三倍的漲幅這個是張老師他所擔心的部分這個媒體也都有相關的報導\n\n17\n00:05:51,417 --> 00:06:13,959\n那另外就是有關於那個台大醫學院的沈麗堅副院長他長期也都很在關心這個藥物的定價還有他本身是一個很傑出的這個藥學教授他長期也都在幫助健保署這邊主持各項的會議\n\n18\n00:06:15,300 --> 00:06:44,549\n他說目前在台灣的健保制度下為了要有效的控管支出所以要定價的方式是以十個已開發中國家的中位數甚至是最低價做目標意思就是說我們的健保制度之下為了要照顧全民眾的健康還有用藥所以盡量希望用比較大的這些額度去爭取到全球或者是相對是比較低價的\n\n19\n00:06:45,189 --> 00:07:00,237\n那為了要避免這個價格的定毛效應所以很多這些大藥廠其實是很擔心一旦不管是新藥或者是其他用藥在台灣透過健保上市的時候呢其實會有一些定毛效應\n\n20\n00:07:01,758 --> 00:07:27,654\n其他國家就說你們可以賣到台灣那為什麼要賣到我不管是哪一個國家東南亞或者是歐盟等等國家包括美國他們就會擔心說能夠賣台灣這麼低那為什麼就不能夠賣到其他國家有一樣的價錢所以為什麼我們的用藥有時候沒有辦法很及時的在台灣上市這個可能也是一個原因\n\n21\n00:07:28,514 --> 00:07:53,838\n尤其是針對癌藥寒藥跟重大疾病不管是新藥或原廠藥的取得跟價格我們根據這一次的關稅的變化我們有什麼樣的衝擊我們如何來因應未來在討論健保制度之下的藥價定位的時候我們目前有沒有什麼方案要來處理這部分不知道部長的意見是如何\n\n22\n00:07:54,369 --> 00:08:21,922\n好非常謝謝委員也敬佩委員收集了真的關心這個主題而且收集了這麼專家的一些意見而且專家這些專家他提供的一些建議我們都覺得有考慮考量的必要以及做準備的必要那當然在策略上最重要就是我們不管什麼藥我們都民眾都用得到特別是\n\n23\n00:08:23,162 --> 00:08:38,834\n相關的剛剛尤其是委員最關心的癌症用藥喊病重大的疾病的一個訓療所以那個當然川普剛剛委員所描述的川普他是用\n\n24\n00:08:40,055 --> 00:08:58,268\n想要用比較低的這個部分當然我們也敬佩我們過去台灣政府的努力都能夠把一些藥品盡量壓到比較低但是時勢所變化必須要讓可能會\n\n25\n00:09:00,912 --> 00:09:26,082\n會漲價但是我們又必須要給民眾能夠用得到藥當然我們就要有多元化的一個政策那當然第一個我們要準備更多的一個譬如說健保的一個預算來準備它的一個應用它的一個變化第二個我們當然也要那個來促進我們的本土的\n\n26\n00:09:27,103 --> 00:09:40,672\n國產的協名藥譬如說輔導國內國產協名藥廠來產製必要的藥品先穩固我們大部分的一個可以做的藥品的供需\n\n27\n00:09:44,479 --> 00:09:59,597\n這一方面當然要建立民眾對學民藥的信賴度讓我們的學民藥能夠使用力能夠提升我想這個衝擊就會比較少我們從這幾個方面來努力這樣子\n\n28\n00:10:00,818 --> 00:10:27,051\n這是一個方向那今年我們為了應應這個關稅訂了特別條例裡面也有爭取到兩百億希望做一個健保因應的措施不過我要提醒的就是說依照歐盟的統計如果是以癌藥為例的話可能就會對每一個民眾使用癌藥的時候會增加一萬個歐元的衝擊差不多三十萬台幣\n\n29\n00:10:29,332 --> 00:10:57,214\n所以我不曉得這個200億裡面到時候如果為了要因應乙癌藥或者是剛剛所看到的重大傷病帶來的這些用藥還有罕病的用藥這很多都是原廠藥那不是說我們自己可以做學名藥就可以處理因為都還在一些保障保護期所以這就不是我們所期待就是說我們自己可以做什麼包括說這些影響跟措施\n\n30\n00:10:58,275 --> 00:11:24,235\n對所以這樣的一個剛剛提的這個中間的空檔我們需要資金來處理這個14場其實也一直都有報告過大概我們也有估算過它的一個數目大概這樣目前的一個狀況加上欠保險的一個裡面的一個空間加上這個基金的挹注\n\n31\n00:11:25,636 --> 00:11:50,160\n我們在剛剛所談到的這些相關的藥品的提供應該是有相當穩定的作用所以這邊我們列了三個建議補充來參考一下這是美國藥價最惠國政策對我國的衝擊的影響評估這個評估可能還要更到位第一點就是研議配合調整新藥與原廠藥的健保給付機制\n\n32\n00:11:50,800 --> 00:12:17,374\n剛才報告的我們現在都用中味價要最低價這種機制這個目前我們已經也有建立有這個機制當然對我們是很好不過你如果考慮到這次關稅的影響或者是相對未來讓民眾在用藥能夠也及時的話這個政策如何去透過好的機制重新檢討\n\n33\n00:12:18,814 --> 00:12:43,883\n當然不是說希望讓我們整體的負擔增加而是說如何能夠在好的機制之下同時去保障我們這個用藥相關的支持性再來就是研議對健保財務增加或致富增加的因應措施這三點的建議請部長來做是的我們都有在進行\n\n34\n00:12:45,123 --> 00:13:05,179\n好再來比較快速的就是有關於這個學名藥自給濾的部分大家已經說很多了所以部長的書面報告裡面也談論了很多我想這部分我們就不再深入那最後有關於美國藥品關稅對我國原尿藥進出口衝擊的評估\n\n35\n00:13:06,880 --> 00:13:33,820\n周副署長其實也有提到我們這些量那再請教一下周副署長就是說我們有沒有根據剛才有人說可能250%有人說100%有人說150%有沒有做差異性分析就是說當這個不同的稅制出現的時候當然現在還是有一點早因為我們也知道川普總統真的是一日三變\n\n36\n00:13:34,620 --> 00:14:00,872\n不過如果我們能夠去做出差異性分析的話那不管是對於進口或出口衝擊會是如何可以讓大家有一個比較知道怎麼去掌握因應的措施這部分不知道副署長有沒有什麼意見可以提供給大家參考是在台美談判小組這邊應該有收集到充分的資訊包含不同的稅率之下對產業有什麼樣的衝擊應該都有做一些相關的準備是\n\n37\n00:14:02,099 --> 00:14:23,941\n好那我們也很期待就是除了不斷的去讓談判可以更順利好成果以外也希望這些差異性分析可以讓民眾可以更安心相關的企業界也可以有好的一個因應的對策好謝謝我們實教室也一直在評估終極好啊OK那是江署長要補充報告\n\n38\n00:14:26,740 --> 00:14:42,433\n蘇美的原料要是0.17億就5億台幣那原來是0%的如果超過30到50%以上生意就不要做了所以我們必須要導引所以產業界他們自己其實要轉生其他非美供應的市場\n\n39\n00:14:43,334 --> 00:15:01,407\n那也有考慮說是不是要去美國去設廠因為本來的不是量不那麼大那最重要的事情是最後他們必須要去做調控就是找到新的一個的目標才是他們最重要的以上好謝謝王振旭委員謝謝部長署長\n\n","tsv":"start\tend\ttext\n7557\t10547\t好 非常感謝主席我們還是請邱部長\n17724\t37410\t菁部長好今天的這個主題我想經過這麼多委員的槌尋剛剛也做了非常完整的說明不過還是有三個問題再跟部長還有跟其他同仁就教一下第一個就是川普藥價最惠國政策對我國藥品價格及供應的衝擊因應的對策\n40331\t66028\t我們第二個部分就是要如何提升我國學民藥的自給率第三個就是美國藥品關稅對我國原料要進出口的影響基本上就是這三個問題那有關於這個川普要加最後一國政策的衝擊我想大家都非常清楚差不多兩月半前這個川普總統就公開的發函\n67409\t96838\t他希望全球17家國際的大藥廠不是只有美國的藥廠而已要大幅降低美國處方藥的價格因為我們都了解很多新藥產出的時候都是從美國開始美國FDA就會通過相關的私營證然後開始做一些藥物的給付在抗癌藥這部分其他的一些新的\n97358\t123286\t不管是新機制或者是一些創新的藥品很多是從美國這邊研發出來的所以他就針對於這個藥價的部分依照經驗還有實際的狀況其實美國的藥價普遍都會比其他國家相對高一點所以他 當然川普就覺得這樣很不爽以外為什麼美國人用藥的價錢會比其他國家的人\n123866\t145913\t還要高所以他就特別希望能夠有好的方式有適當的機制來做這樣的處理所以他要求要17個大藥廠敦促這些大藥廠要降價並且將適當的機制以超額收入能夠回饋給美國的政府當然還有包括美國的人民\n146693\t163220\t所以他要求在9月29號之前他必須要有相關的這個做出承諾要求這個17家的大藥廠能夠配合他的要求如果不配合的話那就看著辦\n164180\t186629\t這個就是我們為什麼今天要花很多的時間精神來討論一下如果這些大藥廠真的針對於我們看到下一張的內容有施大要求他們如果都真的配合這樣的要求的話那對台灣用藥的權益或者是在費用上會造成什麼樣的衝擊跟影響\n187629\t208231\t第一個就是它的世代要求之一要拓展最惠國定價到這個醫療補助裡面第二個是要保證新上市的藥品的最惠國定價就是說反正不管怎麼樣我們美國的藥品不可能要比其他國家的這些用藥還要來得高\n208972\t226100\t就是他做標準就對了他如果比較低 別人不能比他高就是說他要拿到的是最低的藥價讓他那個民眾在用藥上的權益是可以同步的去使用到藥物然後又是全球最低價\n227340\t249847\t第三個就是海外增加的收入要還給美國的患者跟納稅人第四個就是要提供中國的價格的直接採購這個是他具體的要求我們往下看就知道說那為什麼美國要把優惠供給我們台灣為什麼會影響到譬如說我們的優惠要變多貴這到底是什麼邏輯或是什麼理由\n250527\t273007\t那這邊我們看得出來剛剛所提到的因為台灣長期以來是以相對的低價來不管是從美國或者是從其他的地方購入的這個藥品都會比原地可能還要低一點那如果美國政府要求要這個藥廠要壓低價格的話那台灣我們本來是相對於其他\n274007\t296044\t國際的這個用藥價格相對比較低的時候那我們變成是會被要求要漲價的對象就其他17家或其他的藥廠可能就會要求台灣的這個藥價不能夠這麼低這個是我們可以理解的地方所以莊黃仁老師就指出說因為台灣長期以來用低價進入購入這個美國藥品\n297845\t312542\t所以從川普的立場來看這個也很自然啦那吃幾吃那麼久啊所以感覺他這次身為美國總統他要勇敢的或者是要有魄力的站出來要把這個事情能夠做一個徹底的解決\n313403\t329768\t所以當他發現說美國藥廠在海外市場賣得比較便宜回到國內就是說他美國自己發明的藥下去其他的國家電動鼻涕美國國家給所以他一定要把這個筆賬要討回來\n331748\t350544\t所以張老師就表示說如果藥廠重新來訂調整全球的價格的時候台灣有給可能要面臨兩到三倍的漲幅這個是張老師他所擔心的部分這個媒體也都有相關的報導\n351417\t373959\t那另外就是有關於那個台大醫學院的沈麗堅副院長他長期也都很在關心這個藥物的定價還有他本身是一個很傑出的這個藥學教授他長期也都在幫助健保署這邊主持各項的會議\n375300\t404549\t他說目前在台灣的健保制度下為了要有效的控管支出所以要定價的方式是以十個已開發中國家的中位數甚至是最低價做目標意思就是說我們的健保制度之下為了要照顧全民眾的健康還有用藥所以盡量希望用比較大的這些額度去爭取到全球或者是相對是比較低價的\n405189\t420237\t那為了要避免這個價格的定毛效應所以很多這些大藥廠其實是很擔心一旦不管是新藥或者是其他用藥在台灣透過健保上市的時候呢其實會有一些定毛效應\n421758\t447654\t其他國家就說你們可以賣到台灣那為什麼要賣到我不管是哪一個國家東南亞或者是歐盟等等國家包括美國他們就會擔心說能夠賣台灣這麼低那為什麼就不能夠賣到其他國家有一樣的價錢所以為什麼我們的用藥有時候沒有辦法很及時的在台灣上市這個可能也是一個原因\n448514\t473838\t尤其是針對癌藥 寒藥跟重大疾病不管是新藥或原廠藥的取得跟價格我們根據這一次的關稅的變化我們有什麼樣的衝擊我們如何來因應未來在討論健保制度之下的藥價定位的時候我們目前有沒有什麼方案要來處理這部分不知道部長的意見是如何\n474369\t501922\t好 非常謝謝委員 也敬佩委員收集了真的關心這個主題而且收集了這麼專家的一些意見 而且專家這些專家他提供的一些建議我們都覺得有考慮考量的必要 以及做準備的必要那當然在策略上最重要就是我們不管什麼藥我們都民眾都用得到 特別是\n503162\t518834\t相關的剛剛尤其是委員最關心的癌症用藥喊病重大的疾病的一個訓療所以那個當然川普剛剛委員所描述的川普他是用\n520055\t538268\t想要用比較低的這個部分當然我們也敬佩我們過去台灣政府的努力都能夠把一些藥品盡量壓到比較低但是時勢所變化必須要讓可能會\n540912\t566082\t會漲價但是我們又必須要給民眾能夠用得到藥當然我們就要有多元化的一個政策那當然第一個我們要準備更多的一個譬如說健保的一個預算來準備它的一個應用它的一個變化第二個我們當然也要那個來促進我們的本土的\n567103\t580672\t國產的協名藥譬如說輔導國內國產協名藥廠來產製必要的藥品先穩固我們大部分的一個可以做的藥品的供需\n584479\t599597\t這一方面當然要建立民眾對學民藥的信賴度讓我們的學民藥能夠使用力能夠提升我想這個衝擊就會比較少我們從這幾個方面來努力這樣子\n600818\t627051\t這是一個方向那今年我們為了應應這個關稅訂了特別條例裡面也有爭取到兩百億希望做一個健保因應的措施不過我要提醒的就是說依照歐盟的統計如果是以癌藥為例的話可能就會對每一個民眾使用癌藥的時候會增加一萬個歐元的衝擊差不多三十萬台幣\n629332\t657214\t所以我不曉得這個200億裡面到時候如果為了要因應乙癌藥或者是剛剛所看到的重大傷病帶來的這些用藥還有罕病的用藥這很多都是原廠藥那不是說我們自己可以做學名藥就可以處理因為都還在一些保障保護期所以這就不是我們所期待就是說我們自己可以做什麼包括說這些影響跟措施\n658275\t684235\t對 所以這樣的一個 剛剛提的這個中間的空檔我們需要資金來處理這個14場其實也一直都有報告過大概我們也有估算過它的一個數目大概這樣目前的一個狀況加上欠保險的一個裡面的一個空間加上這個基金的挹注\n685636\t710160\t我們在剛剛所談到的這些相關的藥品的提供應該是有相當穩定的作用所以這邊我們列了三個建議補充來參考一下這是美國藥價最惠國政策對我國的衝擊的影響評估這個評估可能還要更到位第一點就是研議配合調整新藥與原廠藥的健保給付機制\n710800\t737374\t剛才報告的我們現在都用中味價 要最低價這種機制這個目前我們已經也有建立有這個機制當然對我們是很好不過你如果考慮到這次關稅的影響或者是相對未來讓民眾在用藥能夠也及時的話這個政策如何去透過好的機制重新檢討\n738814\t763883\t當然不是說希望讓我們整體的負擔增加 而是說如何能夠在好的機制之下 同時去保障我們這個用藥相關的支持性再來就是研議對健保財務增加或致富增加的因應措施 這三點的建議請部長來做 是的 我們都有在進行\n765123\t785179\t好 再來比較快速的就是有關於這個學名藥自給濾的部分大家已經說很多了所以部長的書面報告裡面也談論了很多我想這部分我們就不再深入那最後有關於美國藥品關稅對我國原尿藥進出口衝擊的評估\n786880\t813820\t周副署長其實也有提到我們這些量那再請教一下周副署長就是說我們有沒有根據剛才有人說可能250%有人說100%有人說150%有沒有做差異性分析就是說當這個不同的稅制出現的時候當然現在還是有一點早因為我們也知道川普總統真的是一日三變\n814620\t840872\t不過如果我們能夠去做出差異性分析的話那不管是對於進口或出口衝擊會是如何可以讓大家有一個比較知道怎麼去掌握因應的措施這部分不知道副署長有沒有什麼意見可以提供給大家參考是在台美談判小組這邊應該有收集到充分的資訊包含不同的稅率之下對產業有什麼樣的衝擊應該都有做一些相關的準備是\n842099\t863941\t好 那我們也很期待就是除了不斷的去讓談判可以更順利好成果以外也希望這些差異性分析可以讓民眾可以更安心相關的企業界也可以有好的一個因應的對策好 謝謝我們實教室也一直在評估終極好啊OK 那是江署長要補充報告\n866740\t882433\t蘇美的原料要是0.17億就5億台幣那原來是0%的如果超過30到50%以上生意就不要做了所以我們必須要導引所以產業界他們自己其實要轉生其他非美供應的市場\n883334\t901407\t那也有考慮說是不是要去美國去設廠因為本來的不是量不那麼大那最重要的事情是最後他們必須要去做調控就是找到新的一個的目標才是他們最重要的 以上好謝謝王振旭委員 謝謝部長署長\n","txt":"好 非常感謝主席我們還是請邱部長\n菁部長好今天的這個主題我想經過這麼多委員的槌尋剛剛也做了非常完整的說明不過還是有三個問題再跟部長還有跟其他同仁就教一下第一個就是川普藥價最惠國政策對我國藥品價格及供應的衝擊因應的對策\n我們第二個部分就是要如何提升我國學民藥的自給率第三個就是美國藥品關稅對我國原料要進出口的影響基本上就是這三個問題那有關於這個川普要加最後一國政策的衝擊我想大家都非常清楚差不多兩月半前這個川普總統就公開的發函\n他希望全球17家國際的大藥廠不是只有美國的藥廠而已要大幅降低美國處方藥的價格因為我們都了解很多新藥產出的時候都是從美國開始美國FDA就會通過相關的私營證然後開始做一些藥物的給付在抗癌藥這部分其他的一些新的\n不管是新機制或者是一些創新的藥品很多是從美國這邊研發出來的所以他就針對於這個藥價的部分依照經驗還有實際的狀況其實美國的藥價普遍都會比其他國家相對高一點所以他 當然川普就覺得這樣很不爽以外為什麼美國人用藥的價錢會比其他國家的人\n還要高所以他就特別希望能夠有好的方式有適當的機制來做這樣的處理所以他要求要17個大藥廠敦促這些大藥廠要降價並且將適當的機制以超額收入能夠回饋給美國的政府當然還有包括美國的人民\n所以他要求在9月29號之前他必須要有相關的這個做出承諾要求這個17家的大藥廠能夠配合他的要求如果不配合的話那就看著辦\n這個就是我們為什麼今天要花很多的時間精神來討論一下如果這些大藥廠真的針對於我們看到下一張的內容有施大要求他們如果都真的配合這樣的要求的話那對台灣用藥的權益或者是在費用上會造成什麼樣的衝擊跟影響\n第一個就是它的世代要求之一要拓展最惠國定價到這個醫療補助裡面第二個是要保證新上市的藥品的最惠國定價就是說反正不管怎麼樣我們美國的藥品不可能要比其他國家的這些用藥還要來得高\n就是他做標準就對了他如果比較低 別人不能比他高就是說他要拿到的是最低的藥價讓他那個民眾在用藥上的權益是可以同步的去使用到藥物然後又是全球最低價\n第三個就是海外增加的收入要還給美國的患者跟納稅人第四個就是要提供中國的價格的直接採購這個是他具體的要求我們往下看就知道說那為什麼美國要把優惠供給我們台灣為什麼會影響到譬如說我們的優惠要變多貴這到底是什麼邏輯或是什麼理由\n那這邊我們看得出來剛剛所提到的因為台灣長期以來是以相對的低價來不管是從美國或者是從其他的地方購入的這個藥品都會比原地可能還要低一點那如果美國政府要求要這個藥廠要壓低價格的話那台灣我們本來是相對於其他\n國際的這個用藥價格相對比較低的時候那我們變成是會被要求要漲價的對象就其他17家或其他的藥廠可能就會要求台灣的這個藥價不能夠這麼低這個是我們可以理解的地方所以莊黃仁老師就指出說因為台灣長期以來用低價進入購入這個美國藥品\n所以從川普的立場來看這個也很自然啦那吃幾吃那麼久啊所以感覺他這次身為美國總統他要勇敢的或者是要有魄力的站出來要把這個事情能夠做一個徹底的解決\n所以當他發現說美國藥廠在海外市場賣得比較便宜回到國內就是說他美國自己發明的藥下去其他的國家電動鼻涕美國國家給所以他一定要把這個筆賬要討回來\n所以張老師就表示說如果藥廠重新來訂調整全球的價格的時候台灣有給可能要面臨兩到三倍的漲幅這個是張老師他所擔心的部分這個媒體也都有相關的報導\n那另外就是有關於那個台大醫學院的沈麗堅副院長他長期也都很在關心這個藥物的定價還有他本身是一個很傑出的這個藥學教授他長期也都在幫助健保署這邊主持各項的會議\n他說目前在台灣的健保制度下為了要有效的控管支出所以要定價的方式是以十個已開發中國家的中位數甚至是最低價做目標意思就是說我們的健保制度之下為了要照顧全民眾的健康還有用藥所以盡量希望用比較大的這些額度去爭取到全球或者是相對是比較低價的\n那為了要避免這個價格的定毛效應所以很多這些大藥廠其實是很擔心一旦不管是新藥或者是其他用藥在台灣透過健保上市的時候呢其實會有一些定毛效應\n其他國家就說你們可以賣到台灣那為什麼要賣到我不管是哪一個國家東南亞或者是歐盟等等國家包括美國他們就會擔心說能夠賣台灣這麼低那為什麼就不能夠賣到其他國家有一樣的價錢所以為什麼我們的用藥有時候沒有辦法很及時的在台灣上市這個可能也是一個原因\n尤其是針對癌藥 寒藥跟重大疾病不管是新藥或原廠藥的取得跟價格我們根據這一次的關稅的變化我們有什麼樣的衝擊我們如何來因應未來在討論健保制度之下的藥價定位的時候我們目前有沒有什麼方案要來處理這部分不知道部長的意見是如何\n好 非常謝謝委員 也敬佩委員收集了真的關心這個主題而且收集了這麼專家的一些意見 而且專家這些專家他提供的一些建議我們都覺得有考慮考量的必要 以及做準備的必要那當然在策略上最重要就是我們不管什麼藥我們都民眾都用得到 特別是\n相關的剛剛尤其是委員最關心的癌症用藥喊病重大的疾病的一個訓療所以那個當然川普剛剛委員所描述的川普他是用\n想要用比較低的這個部分當然我們也敬佩我們過去台灣政府的努力都能夠把一些藥品盡量壓到比較低但是時勢所變化必須要讓可能會\n會漲價但是我們又必須要給民眾能夠用得到藥當然我們就要有多元化的一個政策那當然第一個我們要準備更多的一個譬如說健保的一個預算來準備它的一個應用它的一個變化第二個我們當然也要那個來促進我們的本土的\n國產的協名藥譬如說輔導國內國產協名藥廠來產製必要的藥品先穩固我們大部分的一個可以做的藥品的供需\n這一方面當然要建立民眾對學民藥的信賴度讓我們的學民藥能夠使用力能夠提升我想這個衝擊就會比較少我們從這幾個方面來努力這樣子\n這是一個方向那今年我們為了應應這個關稅訂了特別條例裡面也有爭取到兩百億希望做一個健保因應的措施不過我要提醒的就是說依照歐盟的統計如果是以癌藥為例的話可能就會對每一個民眾使用癌藥的時候會增加一萬個歐元的衝擊差不多三十萬台幣\n所以我不曉得這個200億裡面到時候如果為了要因應乙癌藥或者是剛剛所看到的重大傷病帶來的這些用藥還有罕病的用藥這很多都是原廠藥那不是說我們自己可以做學名藥就可以處理因為都還在一些保障保護期所以這就不是我們所期待就是說我們自己可以做什麼包括說這些影響跟措施\n對 所以這樣的一個 剛剛提的這個中間的空檔我們需要資金來處理這個14場其實也一直都有報告過大概我們也有估算過它的一個數目大概這樣目前的一個狀況加上欠保險的一個裡面的一個空間加上這個基金的挹注\n我們在剛剛所談到的這些相關的藥品的提供應該是有相當穩定的作用所以這邊我們列了三個建議補充來參考一下這是美國藥價最惠國政策對我國的衝擊的影響評估這個評估可能還要更到位第一點就是研議配合調整新藥與原廠藥的健保給付機制\n剛才報告的我們現在都用中味價 要最低價這種機制這個目前我們已經也有建立有這個機制當然對我們是很好不過你如果考慮到這次關稅的影響或者是相對未來讓民眾在用藥能夠也及時的話這個政策如何去透過好的機制重新檢討\n當然不是說希望讓我們整體的負擔增加 而是說如何能夠在好的機制之下 同時去保障我們這個用藥相關的支持性再來就是研議對健保財務增加或致富增加的因應措施 這三點的建議請部長來做 是的 我們都有在進行\n好 再來比較快速的就是有關於這個學名藥自給濾的部分大家已經說很多了所以部長的書面報告裡面也談論了很多我想這部分我們就不再深入那最後有關於美國藥品關稅對我國原尿藥進出口衝擊的評估\n周副署長其實也有提到我們這些量那再請教一下周副署長就是說我們有沒有根據剛才有人說可能250%有人說100%有人說150%有沒有做差異性分析就是說當這個不同的稅制出現的時候當然現在還是有一點早因為我們也知道川普總統真的是一日三變\n不過如果我們能夠去做出差異性分析的話那不管是對於進口或出口衝擊會是如何可以讓大家有一個比較知道怎麼去掌握因應的措施這部分不知道副署長有沒有什麼意見可以提供給大家參考是在台美談判小組這邊應該有收集到充分的資訊包含不同的稅率之下對產業有什麼樣的衝擊應該都有做一些相關的準備是\n好 那我們也很期待就是除了不斷的去讓談判可以更順利好成果以外也希望這些差異性分析可以讓民眾可以更安心相關的企業界也可以有好的一個因應的對策好 謝謝我們實教室也一直在評估終極好啊OK 那是江署長要補充報告\n蘇美的原料要是0.17億就5億台幣那原來是0%的如果超過30到50%以上生意就不要做了所以我們必須要導引所以產業界他們自己其實要轉生其他非美供應的市場\n那也有考慮說是不是要去美國去設廠因為本來的不是量不那麼大那最重要的事情是最後他們必須要去做調控就是找到新的一個的目標才是他們最重要的 以上好謝謝王振旭委員 謝謝部長署長\n","vtt":"WEBVTT\n\n00:07.557 --> 00:10.547\n好非常感謝主席我們還是請邱部長\n\n00:17.724 --> 00:37.410\n菁部長好今天的這個主題我想經過這麼多委員的槌尋剛剛也做了非常完整的說明不過還是有三個問題再跟部長還有跟其他同仁就教一下第一個就是川普藥價最惠國政策對我國藥品價格及供應的衝擊因應的對策\n\n00:40.331 --> 01:06.028\n我們第二個部分就是要如何提升我國學民藥的自給率第三個就是美國藥品關稅對我國原料要進出口的影響基本上就是這三個問題那有關於這個川普要加最後一國政策的衝擊我想大家都非常清楚差不多兩月半前這個川普總統就公開的發函\n\n01:07.409 --> 01:36.838\n他希望全球17家國際的大藥廠不是只有美國的藥廠而已要大幅降低美國處方藥的價格因為我們都了解很多新藥產出的時候都是從美國開始美國FDA就會通過相關的私營證然後開始做一些藥物的給付在抗癌藥這部分其他的一些新的\n\n01:37.358 --> 02:03.286\n不管是新機制或者是一些創新的藥品很多是從美國這邊研發出來的所以他就針對於這個藥價的部分依照經驗還有實際的狀況其實美國的藥價普遍都會比其他國家相對高一點所以他當然川普就覺得這樣很不爽以外為什麼美國人用藥的價錢會比其他國家的人\n\n02:03.866 --> 02:25.913\n還要高所以他就特別希望能夠有好的方式有適當的機制來做這樣的處理所以他要求要17個大藥廠敦促這些大藥廠要降價並且將適當的機制以超額收入能夠回饋給美國的政府當然還有包括美國的人民\n\n02:26.693 --> 02:43.220\n所以他要求在9月29號之前他必須要有相關的這個做出承諾要求這個17家的大藥廠能夠配合他的要求如果不配合的話那就看著辦\n\n02:44.180 --> 03:06.629\n這個就是我們為什麼今天要花很多的時間精神來討論一下如果這些大藥廠真的針對於我們看到下一張的內容有施大要求他們如果都真的配合這樣的要求的話那對台灣用藥的權益或者是在費用上會造成什麼樣的衝擊跟影響\n\n03:07.629 --> 03:28.231\n第一個就是它的世代要求之一要拓展最惠國定價到這個醫療補助裡面第二個是要保證新上市的藥品的最惠國定價就是說反正不管怎麼樣我們美國的藥品不可能要比其他國家的這些用藥還要來得高\n\n03:28.972 --> 03:46.100\n就是他做標準就對了他如果比較低別人不能比他高就是說他要拿到的是最低的藥價讓他那個民眾在用藥上的權益是可以同步的去使用到藥物然後又是全球最低價\n\n03:47.340 --> 04:09.847\n第三個就是海外增加的收入要還給美國的患者跟納稅人第四個就是要提供中國的價格的直接採購這個是他具體的要求我們往下看就知道說那為什麼美國要把優惠供給我們台灣為什麼會影響到譬如說我們的優惠要變多貴這到底是什麼邏輯或是什麼理由\n\n04:10.527 --> 04:33.007\n那這邊我們看得出來剛剛所提到的因為台灣長期以來是以相對的低價來不管是從美國或者是從其他的地方購入的這個藥品都會比原地可能還要低一點那如果美國政府要求要這個藥廠要壓低價格的話那台灣我們本來是相對於其他\n\n04:34.007 --> 04:56.044\n國際的這個用藥價格相對比較低的時候那我們變成是會被要求要漲價的對象就其他17家或其他的藥廠可能就會要求台灣的這個藥價不能夠這麼低這個是我們可以理解的地方所以莊黃仁老師就指出說因為台灣長期以來用低價進入購入這個美國藥品\n\n04:57.845 --> 05:12.542\n所以從川普的立場來看這個也很自然啦那吃幾吃那麼久啊所以感覺他這次身為美國總統他要勇敢的或者是要有魄力的站出來要把這個事情能夠做一個徹底的解決\n\n05:13.403 --> 05:29.768\n所以當他發現說美國藥廠在海外市場賣得比較便宜回到國內就是說他美國自己發明的藥下去其他的國家電動鼻涕美國國家給所以他一定要把這個筆賬要討回來\n\n05:31.748 --> 05:50.544\n所以張老師就表示說如果藥廠重新來訂調整全球的價格的時候台灣有給可能要面臨兩到三倍的漲幅這個是張老師他所擔心的部分這個媒體也都有相關的報導\n\n05:51.417 --> 06:13.959\n那另外就是有關於那個台大醫學院的沈麗堅副院長他長期也都很在關心這個藥物的定價還有他本身是一個很傑出的這個藥學教授他長期也都在幫助健保署這邊主持各項的會議\n\n06:15.300 --> 06:44.549\n他說目前在台灣的健保制度下為了要有效的控管支出所以要定價的方式是以十個已開發中國家的中位數甚至是最低價做目標意思就是說我們的健保制度之下為了要照顧全民眾的健康還有用藥所以盡量希望用比較大的這些額度去爭取到全球或者是相對是比較低價的\n\n06:45.189 --> 07:00.237\n那為了要避免這個價格的定毛效應所以很多這些大藥廠其實是很擔心一旦不管是新藥或者是其他用藥在台灣透過健保上市的時候呢其實會有一些定毛效應\n\n07:01.758 --> 07:27.654\n其他國家就說你們可以賣到台灣那為什麼要賣到我不管是哪一個國家東南亞或者是歐盟等等國家包括美國他們就會擔心說能夠賣台灣這麼低那為什麼就不能夠賣到其他國家有一樣的價錢所以為什麼我們的用藥有時候沒有辦法很及時的在台灣上市這個可能也是一個原因\n\n07:28.514 --> 07:53.838\n尤其是針對癌藥寒藥跟重大疾病不管是新藥或原廠藥的取得跟價格我們根據這一次的關稅的變化我們有什麼樣的衝擊我們如何來因應未來在討論健保制度之下的藥價定位的時候我們目前有沒有什麼方案要來處理這部分不知道部長的意見是如何\n\n07:54.369 --> 08:21.922\n好非常謝謝委員也敬佩委員收集了真的關心這個主題而且收集了這麼專家的一些意見而且專家這些專家他提供的一些建議我們都覺得有考慮考量的必要以及做準備的必要那當然在策略上最重要就是我們不管什麼藥我們都民眾都用得到特別是\n\n08:23.162 --> 08:38.834\n相關的剛剛尤其是委員最關心的癌症用藥喊病重大的疾病的一個訓療所以那個當然川普剛剛委員所描述的川普他是用\n\n08:40.055 --> 08:58.268\n想要用比較低的這個部分當然我們也敬佩我們過去台灣政府的努力都能夠把一些藥品盡量壓到比較低但是時勢所變化必須要讓可能會\n\n09:00.912 --> 09:26.082\n會漲價但是我們又必須要給民眾能夠用得到藥當然我們就要有多元化的一個政策那當然第一個我們要準備更多的一個譬如說健保的一個預算來準備它的一個應用它的一個變化第二個我們當然也要那個來促進我們的本土的\n\n09:27.103 --> 09:40.672\n國產的協名藥譬如說輔導國內國產協名藥廠來產製必要的藥品先穩固我們大部分的一個可以做的藥品的供需\n\n09:44.479 --> 09:59.597\n這一方面當然要建立民眾對學民藥的信賴度讓我們的學民藥能夠使用力能夠提升我想這個衝擊就會比較少我們從這幾個方面來努力這樣子\n\n10:00.818 --> 10:27.051\n這是一個方向那今年我們為了應應這個關稅訂了特別條例裡面也有爭取到兩百億希望做一個健保因應的措施不過我要提醒的就是說依照歐盟的統計如果是以癌藥為例的話可能就會對每一個民眾使用癌藥的時候會增加一萬個歐元的衝擊差不多三十萬台幣\n\n10:29.332 --> 10:57.214\n所以我不曉得這個200億裡面到時候如果為了要因應乙癌藥或者是剛剛所看到的重大傷病帶來的這些用藥還有罕病的用藥這很多都是原廠藥那不是說我們自己可以做學名藥就可以處理因為都還在一些保障保護期所以這就不是我們所期待就是說我們自己可以做什麼包括說這些影響跟措施\n\n10:58.275 --> 11:24.235\n對所以這樣的一個剛剛提的這個中間的空檔我們需要資金來處理這個14場其實也一直都有報告過大概我們也有估算過它的一個數目大概這樣目前的一個狀況加上欠保險的一個裡面的一個空間加上這個基金的挹注\n\n11:25.636 --> 11:50.160\n我們在剛剛所談到的這些相關的藥品的提供應該是有相當穩定的作用所以這邊我們列了三個建議補充來參考一下這是美國藥價最惠國政策對我國的衝擊的影響評估這個評估可能還要更到位第一點就是研議配合調整新藥與原廠藥的健保給付機制\n\n11:50.800 --> 12:17.374\n剛才報告的我們現在都用中味價要最低價這種機制這個目前我們已經也有建立有這個機制當然對我們是很好不過你如果考慮到這次關稅的影響或者是相對未來讓民眾在用藥能夠也及時的話這個政策如何去透過好的機制重新檢討\n\n12:18.814 --> 12:43.883\n當然不是說希望讓我們整體的負擔增加而是說如何能夠在好的機制之下同時去保障我們這個用藥相關的支持性再來就是研議對健保財務增加或致富增加的因應措施這三點的建議請部長來做是的我們都有在進行\n\n12:45.123 --> 13:05.179\n好再來比較快速的就是有關於這個學名藥自給濾的部分大家已經說很多了所以部長的書面報告裡面也談論了很多我想這部分我們就不再深入那最後有關於美國藥品關稅對我國原尿藥進出口衝擊的評估\n\n13:06.880 --> 13:33.820\n周副署長其實也有提到我們這些量那再請教一下周副署長就是說我們有沒有根據剛才有人說可能250%有人說100%有人說150%有沒有做差異性分析就是說當這個不同的稅制出現的時候當然現在還是有一點早因為我們也知道川普總統真的是一日三變\n\n13:34.620 --> 14:00.872\n不過如果我們能夠去做出差異性分析的話那不管是對於進口或出口衝擊會是如何可以讓大家有一個比較知道怎麼去掌握因應的措施這部分不知道副署長有沒有什麼意見可以提供給大家參考是在台美談判小組這邊應該有收集到充分的資訊包含不同的稅率之下對產業有什麼樣的衝擊應該都有做一些相關的準備是\n\n14:02.099 --> 14:23.941\n好那我們也很期待就是除了不斷的去讓談判可以更順利好成果以外也希望這些差異性分析可以讓民眾可以更安心相關的企業界也可以有好的一個因應的對策好謝謝我們實教室也一直在評估終極好啊OK那是江署長要補充報告\n\n14:26.740 --> 14:42.433\n蘇美的原料要是0.17億就5億台幣那原來是0%的如果超過30到50%以上生意就不要做了所以我們必須要導引所以產業界他們自己其實要轉生其他非美供應的市場\n\n14:43.334 --> 15:01.407\n那也有考慮說是不是要去美國去設廠因為本來的不是量不那麼大那最重要的事情是最後他們必須要去做調控就是找到新的一個的目標才是他們最重要的以上好謝謝王振旭委員謝謝部長署長\n\n","segments":[{"start":7.557,"end":10.547,"text":"好 非常感謝主席我們還是請邱部長"},{"start":17.724,"end":37.41,"text":"菁部長好今天的這個主題我想經過這麼多委員的槌尋剛剛也做了非常完整的說明不過還是有三個問題再跟部長還有跟其他同仁就教一下第一個就是川普藥價最惠國政策對我國藥品價格及供應的衝擊因應的對策"},{"start":40.331,"end":66.028,"text":"我們第二個部分就是要如何提升我國學民藥的自給率第三個就是美國藥品關稅對我國原料要進出口的影響基本上就是這三個問題那有關於這個川普要加最後一國政策的衝擊我想大家都非常清楚差不多兩月半前這個川普總統就公開的發函"},{"start":67.409,"end":96.838,"text":"他希望全球17家國際的大藥廠不是只有美國的藥廠而已要大幅降低美國處方藥的價格因為我們都了解很多新藥產出的時候都是從美國開始美國FDA就會通過相關的私營證然後開始做一些藥物的給付在抗癌藥這部分其他的一些新的"},{"start":97.358,"end":123.286,"text":"不管是新機制或者是一些創新的藥品很多是從美國這邊研發出來的所以他就針對於這個藥價的部分依照經驗還有實際的狀況其實美國的藥價普遍都會比其他國家相對高一點所以他 當然川普就覺得這樣很不爽以外為什麼美國人用藥的價錢會比其他國家的人"},{"start":123.866,"end":145.913,"text":"還要高所以他就特別希望能夠有好的方式有適當的機制來做這樣的處理所以他要求要17個大藥廠敦促這些大藥廠要降價並且將適當的機制以超額收入能夠回饋給美國的政府當然還有包括美國的人民"},{"start":146.693,"end":163.22,"text":"所以他要求在9月29號之前他必須要有相關的這個做出承諾要求這個17家的大藥廠能夠配合他的要求如果不配合的話那就看著辦"},{"start":164.18,"end":186.629,"text":"這個就是我們為什麼今天要花很多的時間精神來討論一下如果這些大藥廠真的針對於我們看到下一張的內容有施大要求他們如果都真的配合這樣的要求的話那對台灣用藥的權益或者是在費用上會造成什麼樣的衝擊跟影響"},{"start":187.629,"end":208.231,"text":"第一個就是它的世代要求之一要拓展最惠國定價到這個醫療補助裡面第二個是要保證新上市的藥品的最惠國定價就是說反正不管怎麼樣我們美國的藥品不可能要比其他國家的這些用藥還要來得高"},{"start":208.972,"end":226.1,"text":"就是他做標準就對了他如果比較低 別人不能比他高就是說他要拿到的是最低的藥價讓他那個民眾在用藥上的權益是可以同步的去使用到藥物然後又是全球最低價"},{"start":227.34,"end":249.847,"text":"第三個就是海外增加的收入要還給美國的患者跟納稅人第四個就是要提供中國的價格的直接採購這個是他具體的要求我們往下看就知道說那為什麼美國要把優惠供給我們台灣為什麼會影響到譬如說我們的優惠要變多貴這到底是什麼邏輯或是什麼理由"},{"start":250.527,"end":273.007,"text":"那這邊我們看得出來剛剛所提到的因為台灣長期以來是以相對的低價來不管是從美國或者是從其他的地方購入的這個藥品都會比原地可能還要低一點那如果美國政府要求要這個藥廠要壓低價格的話那台灣我們本來是相對於其他"},{"start":274.007,"end":296.044,"text":"國際的這個用藥價格相對比較低的時候那我們變成是會被要求要漲價的對象就其他17家或其他的藥廠可能就會要求台灣的這個藥價不能夠這麼低這個是我們可以理解的地方所以莊黃仁老師就指出說因為台灣長期以來用低價進入購入這個美國藥品"},{"start":297.845,"end":312.542,"text":"所以從川普的立場來看這個也很自然啦那吃幾吃那麼久啊所以感覺他這次身為美國總統他要勇敢的或者是要有魄力的站出來要把這個事情能夠做一個徹底的解決"},{"start":313.403,"end":329.768,"text":"所以當他發現說美國藥廠在海外市場賣得比較便宜回到國內就是說他美國自己發明的藥下去其他的國家電動鼻涕美國國家給所以他一定要把這個筆賬要討回來"},{"start":331.748,"end":350.544,"text":"所以張老師就表示說如果藥廠重新來訂調整全球的價格的時候台灣有給可能要面臨兩到三倍的漲幅這個是張老師他所擔心的部分這個媒體也都有相關的報導"},{"start":351.417,"end":373.959,"text":"那另外就是有關於那個台大醫學院的沈麗堅副院長他長期也都很在關心這個藥物的定價還有他本身是一個很傑出的這個藥學教授他長期也都在幫助健保署這邊主持各項的會議"},{"start":375.3,"end":404.549,"text":"他說目前在台灣的健保制度下為了要有效的控管支出所以要定價的方式是以十個已開發中國家的中位數甚至是最低價做目標意思就是說我們的健保制度之下為了要照顧全民眾的健康還有用藥所以盡量希望用比較大的這些額度去爭取到全球或者是相對是比較低價的"},{"start":405.189,"end":420.237,"text":"那為了要避免這個價格的定毛效應所以很多這些大藥廠其實是很擔心一旦不管是新藥或者是其他用藥在台灣透過健保上市的時候呢其實會有一些定毛效應"},{"start":421.758,"end":447.654,"text":"其他國家就說你們可以賣到台灣那為什麼要賣到我不管是哪一個國家東南亞或者是歐盟等等國家包括美國他們就會擔心說能夠賣台灣這麼低那為什麼就不能夠賣到其他國家有一樣的價錢所以為什麼我們的用藥有時候沒有辦法很及時的在台灣上市這個可能也是一個原因"},{"start":448.514,"end":473.838,"text":"尤其是針對癌藥 寒藥跟重大疾病不管是新藥或原廠藥的取得跟價格我們根據這一次的關稅的變化我們有什麼樣的衝擊我們如何來因應未來在討論健保制度之下的藥價定位的時候我們目前有沒有什麼方案要來處理這部分不知道部長的意見是如何"},{"start":474.369,"end":501.922,"text":"好 非常謝謝委員 也敬佩委員收集了真的關心這個主題而且收集了這麼專家的一些意見 而且專家這些專家他提供的一些建議我們都覺得有考慮考量的必要 以及做準備的必要那當然在策略上最重要就是我們不管什麼藥我們都民眾都用得到 特別是"},{"start":503.162,"end":518.834,"text":"相關的剛剛尤其是委員最關心的癌症用藥喊病重大的疾病的一個訓療所以那個當然川普剛剛委員所描述的川普他是用"},{"start":520.055,"end":538.268,"text":"想要用比較低的這個部分當然我們也敬佩我們過去台灣政府的努力都能夠把一些藥品盡量壓到比較低但是時勢所變化必須要讓可能會"},{"start":540.912,"end":566.082,"text":"會漲價但是我們又必須要給民眾能夠用得到藥當然我們就要有多元化的一個政策那當然第一個我們要準備更多的一個譬如說健保的一個預算來準備它的一個應用它的一個變化第二個我們當然也要那個來促進我們的本土的"},{"start":567.103,"end":580.672,"text":"國產的協名藥譬如說輔導國內國產協名藥廠來產製必要的藥品先穩固我們大部分的一個可以做的藥品的供需"},{"start":584.479,"end":599.597,"text":"這一方面當然要建立民眾對學民藥的信賴度讓我們的學民藥能夠使用力能夠提升我想這個衝擊就會比較少我們從這幾個方面來努力這樣子"},{"start":600.818,"end":627.051,"text":"這是一個方向那今年我們為了應應這個關稅訂了特別條例裡面也有爭取到兩百億希望做一個健保因應的措施不過我要提醒的就是說依照歐盟的統計如果是以癌藥為例的話可能就會對每一個民眾使用癌藥的時候會增加一萬個歐元的衝擊差不多三十萬台幣"},{"start":629.332,"end":657.214,"text":"所以我不曉得這個200億裡面到時候如果為了要因應乙癌藥或者是剛剛所看到的重大傷病帶來的這些用藥還有罕病的用藥這很多都是原廠藥那不是說我們自己可以做學名藥就可以處理因為都還在一些保障保護期所以這就不是我們所期待就是說我們自己可以做什麼包括說這些影響跟措施"},{"start":658.275,"end":684.235,"text":"對 所以這樣的一個 剛剛提的這個中間的空檔我們需要資金來處理這個14場其實也一直都有報告過大概我們也有估算過它的一個數目大概這樣目前的一個狀況加上欠保險的一個裡面的一個空間加上這個基金的挹注"},{"start":685.636,"end":710.16,"text":"我們在剛剛所談到的這些相關的藥品的提供應該是有相當穩定的作用所以這邊我們列了三個建議補充來參考一下這是美國藥價最惠國政策對我國的衝擊的影響評估這個評估可能還要更到位第一點就是研議配合調整新藥與原廠藥的健保給付機制"},{"start":710.8,"end":737.374,"text":"剛才報告的我們現在都用中味價 要最低價這種機制這個目前我們已經也有建立有這個機制當然對我們是很好不過你如果考慮到這次關稅的影響或者是相對未來讓民眾在用藥能夠也及時的話這個政策如何去透過好的機制重新檢討"},{"start":738.814,"end":763.883,"text":"當然不是說希望讓我們整體的負擔增加 而是說如何能夠在好的機制之下 同時去保障我們這個用藥相關的支持性再來就是研議對健保財務增加或致富增加的因應措施 這三點的建議請部長來做 是的 我們都有在進行"},{"start":765.123,"end":785.179,"text":"好 再來比較快速的就是有關於這個學名藥自給濾的部分大家已經說很多了所以部長的書面報告裡面也談論了很多我想這部分我們就不再深入那最後有關於美國藥品關稅對我國原尿藥進出口衝擊的評估"},{"start":786.88,"end":813.82,"text":"周副署長其實也有提到我們這些量那再請教一下周副署長就是說我們有沒有根據剛才有人說可能250%有人說100%有人說150%有沒有做差異性分析就是說當這個不同的稅制出現的時候當然現在還是有一點早因為我們也知道川普總統真的是一日三變"},{"start":814.62,"end":840.872,"text":"不過如果我們能夠去做出差異性分析的話那不管是對於進口或出口衝擊會是如何可以讓大家有一個比較知道怎麼去掌握因應的措施這部分不知道副署長有沒有什麼意見可以提供給大家參考是在台美談判小組這邊應該有收集到充分的資訊包含不同的稅率之下對產業有什麼樣的衝擊應該都有做一些相關的準備是"},{"start":842.099,"end":863.941,"text":"好 那我們也很期待就是除了不斷的去讓談判可以更順利好成果以外也希望這些差異性分析可以讓民眾可以更安心相關的企業界也可以有好的一個因應的對策好 謝謝我們實教室也一直在評估終極好啊OK 那是江署長要補充報告"},{"start":866.74,"end":882.433,"text":"蘇美的原料要是0.17億就5億台幣那原來是0%的如果超過30到50%以上生意就不要做了所以我們必須要導引所以產業界他們自己其實要轉生其他非美供應的市場"},{"start":883.334,"end":901.407,"text":"那也有考慮說是不是要去美國去設廠因為本來的不是量不那麼大那最重要的事情是最後他們必須要去做調控就是找到新的一個的目標才是他們最重要的 以上好謝謝王振旭委員 謝謝部長署長"}]}}},"gazette":{"lineno":740,"blocks":[["王委員正旭：（11時52分）非常感謝主席，我們還是請邱部長。"],["主席：部長請。"],["邱部長泰源：委員好。"],["王委員正旭：邱部長好。今天這個主題經過這麼多委員的垂詢，剛剛也做了非常完整的說明，不過還是有3個問題再跟部長還有其他同仁就教一下：第一個，川普藥價最惠國政策對我國藥品價格及供應的衝擊與因應對策；第二個部分，如何提升我國學名藥的自給率；第三個，美國藥品關稅對我國原料藥進出口的影響。基本上就是這3個問題。","有關於川普藥價最惠國政策的衝擊，我想大家都非常清楚，差不多兩個禮拜前川普總統就公開發函，他希望全球17家國際大藥廠，不是只有美國本土的藥廠而已，要大幅降低美國處方藥的價格。因為我們都了解，很多新藥產出的時候都是從美國開始，美國FDA就會通過相關的適應症，然後開始做一些藥物的給付，在抗癌藥這部分，不管是新機制或者是一些創新的藥品，很多是從美國這邊研發出來的，所以關於藥價部分，依照經驗還有實際的狀況，其實美國的藥價普遍都會比其他國家相對高一點。當然川普因為這樣就覺得很不爽，為什麼美國人用藥的價錢會比其他國家的人還要高？所以他就特別希望能夠有好的方式、適當的機制來做這樣的處理，因此他要求17個大藥廠、敦促這些大藥廠要降價，並且以適當的機制將超額收入回饋給美國政府，當然還有包括美國的人民，所以他要求在9月29號之前必須要做出相關的承諾，要求這17家的大藥廠能夠配合他的要求，如果不配合的話，那就看著辦。這就是我們為什麼今天要花很多的時間、精神來討論，下一張簡報內容有對藥廠的四大要求，如果這些大藥廠真的都配合這樣的要求的話，對臺灣的用藥權益或者是在費用上會造成什麼樣的衝擊跟影響？","關於他的四大要求：第一個，拓展最惠國定價到醫療補助裡面；第二個，保證新上市藥品的最惠國定價，也就是說，不管怎麼樣，美國的藥品不能比其他國家的用藥來得高，就是以他做標準就對了，他如果比較低，別人不能比他更低，就是他要拿到最低的藥價，讓他的民眾在用藥權益上可以同步使用到藥物，然後又是全球最低價；第三個，海外增加的收入要返還給美國的患者跟納稅人；第四個，要提供最惠國價格的直接採購，這是他的具體要求。","往下看就知道，為什麼美國要降低藥價會影響到我們臺灣？譬如我們臺灣的藥價會變得比較貴，這到底是什麼邏輯或是什麼理由？這邊我們也看得出來剛剛所提到的，因為臺灣長期以來是以相對低價，不管是從美國或者是從其他地方購入藥品，都會比原地可能還要低一點，如果美國政府要求藥廠要壓低價格的話，臺灣本來相對於其他國際上的用藥價格比較低，我們會變成被要求漲價的對象，就是17家或其他藥廠可能就會要求臺灣的藥價不能夠這麼低，這個是我們可以理解的地方。","所以張鴻仁老師就指出，因為臺灣長期以來用低價購入美國藥品，所以從川普的立場來看，這個也很自然啦，吃虧吃那麼久了，所以這次身為美國總統，他要勇敢的或者是有魄力的站出來，把這個事情做一個徹底的解決，所以當他發現美國藥廠在海外市場賣得比較便宜，就是美國自己發明的藥物賣去其他國家反而價格比美國更低，他就一定要把這筆帳討回來。因此張鴻仁老師就表示，如果藥廠重新調整全球價格的時候，臺灣的藥價可能要面臨兩到三倍的漲幅，這是張老師所擔心的部分，媒體也都有相關的報導。","另外，臺大醫學院的沈麗娟副院長也都長期關心藥物的定價，還有他本身是一個很傑出的藥學教授，他長期也都在幫助健保署主持各項的會議。他說目前在臺灣的這個健保制度下，為了要有效的控管支出，所以藥價定價的方式是以10個已開發中國家的中位數，甚至是最低價做目標。意思就是說，在我們的健保制度之下，為了要照顧全民的健康還有用藥，所以希望儘量用比較大的額度去爭取到全球或者是相對比較低價。為了避免價格的定錨效應，所以很多大藥廠其實很擔心，不管是新藥或者是其他用藥，在臺灣透過健保上市的時候其實會有一些定錨效應，就是其他國家會認為你們可以賣臺灣那麼低，不管是哪一個國家，東南亞或者是歐盟等等國家，包括美國，他們就會擔心，既然能夠賣臺灣這麼低，為什麼賣到其他國家不能也是一樣的價錢。所以為什麼我們的用藥有時候沒有辦法很即時的在臺灣上市？這個可能也是一個原因。","尤其是針對癌藥、罕藥跟重大疾病，不管是新藥或原廠藥的取得與價格，根據這一次關稅的變化，對我們有什麼樣的衝擊？要如何來因應？未來在討論健保制度之下的藥價定位的時候，我們目前有沒有什麼方案要來處理？這部分不知道部長的意見是如何？"],["邱部長泰源：非常謝謝委員，也敬佩委員真的關心這個主題，而且蒐集了這麼多專家的意見，這些專家提供的建議我們都覺得有考慮、考量的必要，以及做準備的必要，當然在策略上最重要就是不管什麼藥我們民眾都用得到，特別是相關的，尤其是委員最關心的癌症用藥、罕病及重大疾病的新藥。","當然以剛剛委員所描述的，川普是想要用比較低的價格，不能說賣美國都比較貴嘛！在這個部分，我們也敬佩過去臺灣政府的努力，都能夠把一些藥品儘量壓到比較低，不過時勢變化，藥品可能會漲價，但是又必須讓民眾能夠用得到藥，當然我們就要有多元化的政策，第一個，我們要有更多的準備，譬如說以健保的預算來因應它的變化。第二個，我們也要來促進本土國產的學名藥，譬如說輔導國內國產學名藥廠來產製必要的藥品，先穩固我們可以做的藥品的供需，當然這一方面也要建立民眾對學名藥的信賴度，讓學名藥的使用率能夠提升，我想這樣衝擊就會比較少，我們從這幾個方面來努力。"],["王委員正旭：是，當然這是一個方向，今年我們為了因應關稅所制定的特別條例裡面也有爭取到200億，希望做一個健保因應的措施，不過我要提醒的是，依照歐盟的統計，如果以癌藥為例的話，每一個民眾使用癌藥的時候可能會增加1萬歐元的衝擊，差不多30萬臺幣嘛！所以我不曉得這個200億裡面，到時候如果為了要因應癌藥或者是重大傷病帶來的這些用藥，還有罕病的用藥，這些很多都是原廠藥，不是我們自己做學名藥就能夠處理的，因為藥品都還在保護期嘛！所以這不是我們所期待，說我們自己可以做什麼而已，包括這些影響和措施，這個……"],["邱部長泰源：對，所以剛剛你提的這個中間的空檔我們需要資金來處理，石署長其實一直都有報告過，我們也有估算過它的數目，以目前的狀況加上健保裡面的空間，加上基金的挹注，對於剛剛所談到的這些相關藥品的提供，應該是有相當穩定的作用。"],["王委員正旭：是，所以這邊我們列了三個建議給部長參考一下，第一點是美國藥價最惠國政策對我國的衝擊影響評估，這個評估可能還要更到位。"],["邱部長泰源：是。"],["王委員正旭：第二點是研議配合調整新藥與原廠藥的健保給付機制，剛剛跟你報告過，我們現在都用中位數、要最低價，這種機制是不是要再重新檢討？"],["邱部長泰源：這個我們目前已經有建立，有這個機制。"],["王委員正旭：當然那個對我們是很好，不過你如果考慮到這一次關稅的影響，或者是相對未來讓民眾在用藥也能夠即時的話，這個政策如何去透過好的機制重新檢討，當然不是希望藥品讓我們整體的負擔增加，而是說如何能夠在好的機制之下，同時去保障我們用藥相關的一些即時性。"],["邱部長泰源：是，這是一定要堅持的。"],["王委員正旭：再來是研議對健保財務增加或自付增加的因應措施，這三點建議就請部長來做一些……"],["邱部長泰源：是的，我們都有在進行。"],["王委員正旭：好。接下來比較快速地帶過有關於學名藥自給率的部分，這個大家已經說很多了，在部長的書面報告裡面也談論了很多，這部分我們就不再深入。","最後，有關於美國藥品關稅對我國原料藥進出口衝擊的評估，鄒副署長其實也有提到我們的一些量嘛！再請教一下鄒副署長，剛才有人說可能是250%，有人說100%，有的說150%，有沒有做差異性分析？就是說當不同稅制出現的時候，當然現在還是有一點早，因為我們也知道川普總統真的是一日三變，不過如果我們能夠去做出差異性分析的話，不管對於進口或出口的衝擊會是如何，可以讓大家比較知道怎麼去掌握因應的措施，這部分不曉得副署長有沒有什麼意見可以提供給大家參考？"],["鄒副署長宇新：是，在臺美談判小組這邊應該有蒐集到充分的資訊，包含不同的稅率之下對產業有什麼樣的衝擊，應該都有做一些相關的準備。"],["王委員正旭：好，那我們也很期待，除了不斷地去讓談判可以更順利有好成果以外，也希望這些差異性分析可以讓民眾更安心，相關的企業界也可以有好的因應對策，好，謝謝，要再打拚。"],["邱部長泰源：我們食藥署有一直在評估衝擊。"],["王委員正旭：好，姜署長也要補充報告。"],["姜署長至剛：輸美的原料藥是0.17億美元，就是5億臺幣，原來是0%的如果超過30到50%以上，生意就不要做了，所以我們必須要導引，產業界他們自己其實要轉身到其他非美供應的市場，也有考慮說是不是要去美國設廠，因為本來的量不是那麼大。最重要的事情是，最後他們必須要去做調控，找到一個新的目標才是他們最重要的，以上。"],["王委員正旭：好，謝謝。"],["邱部長泰源：好，謝謝委員。"],["主席：謝謝王正旭委員，謝謝部長、署長。","陳培瑜、陳培瑜、陳培瑜委員不在。","請葉元之委員質詢。"]],"agenda":{"page_end":328,"meet_id":"委員會-11-3-26-24","speakers":["蘇清泉","陳昭姿","林月琴","陳菁徽","邱鎮軍","王育敏","廖偉翔","盧縣一","林淑芬","黃秀芳","王正旭","葉元之","陳瑩","劉建國","楊曜","涂權吉"],"page_start":267,"meetingDate":["2025-08-14"],"gazette_id":"1147202","agenda_lcidc_ids":["1147202_00007"],"meet_name":"立法院第11屆第3會期社會福利及衛生環境委員會第24次全體委員會議紀錄","content":"邀請衛生福利部、經濟部、財政部就「美國針對進口藥品、原料藥課稅對我國產業造成影響」進\n行專題報告，並備質詢","agenda_id":"1147202_00006"}}}