Challenge:   Taiwan has a western style central government reimbursement system characterized by frequent, strict cost containment measures. The legislative body, the Yuan, has significant influence over the health budget as well as the discreet measures enacted to drive down medicine costs yearly. Funds to cover routine vaccinations exist for only bare minimum vaccination requirements. The company sought to introduce a pediatric vaccine that if accepted at the global average price/dose level would have required the government vaccine budget to grow 300%. There was no sense of urgency among health authorities to include the vaccine in a national program. To generate awareness of the value of the vaccine, the company decided to take a 2-pronged approach from the bottom (parents) and the top (legislators) to create awareness of the protective value of the vaccine to Taiwan's children. Realizing that a full-fledged national reimbursement program in the short term was unlikely given the huge expense, the company took another 2-sided approach to seek regional immunization programs through provincial governments while it lobbied in the Yuan to change the immunization law to make national reimbursement possible.

Strategy :   The stakeholder plan the General Manager orchestrated was among the most complex the company had ever undertaken because of the performance milestones linked to provincial agreements building up to a true national scheme that would negate the need for provincial reimbursement. This was very much like peeling the onion a layer at a time to reach the core representing commercial success via national reimbursement for all vaccinated children. The affiliate team divided its tasks among provincial decision-makers, Yuan members and Department of Health (BNHI) officials to choreograph the timing and content of each visit it made. Once a reasonable public awareness of the disease burden and available solution had been generated via media stories and parents' groups actions, the company brought in international disease experts, at one point obtaining a well publicized meeting with the Prime Minister. A major element in the negotiation strategy with provincial governments was the engagement of medical and economics experts who attested to the cost effectiveness of the vaccine. Leading KOLs ultimately as a group endorsed a national vaccination program but the budget challenge still remained.

Outcome:   The company has won 7 regional tenders for its product as the national vaccination fund debate winds its way through the Yuan. Meanwhile, public awareness has helped stimulate significant private market, 100% parent pay sales while the legislature debates how to implement a new law to address the inequity of some parents paying little or nothing while others pay 100% dependent upon where one lives in Taiwan. This case demonstrates the importance of an expansive stakeholder plan that addresses several moving parts simultaneously. The negotiation preparedness focused more on who initially should receive the vaccine (e.g., high risk children, those in daycare facilities) than on the price the government would pay. The national immunization plan will be introduced in stages to allow the government to absorb the budget shock. Meanwhile the company lays the groundwork for a more complicated negotiation as it plans to introduce a successor generation of its vaccine at a time when the government's national program should be fully funded.