Two Cases — Tips for Navigating Taiwan NHI Coverage
台大雲林分院腎臟科 紀竣議
Nephrology Division, National Taiwan University Hospital Yunlin Branch
Jun 2026
REFERENCES
1. Irazabal MV, et al. Imaging Classification of Autosomal Dominant Polycystic Kidney Disease: A Simple Model for Selecting Patients for Clinical Trials. J Am Soc Nephrol. 2015;26(1):160–172.
2. Mayo Clinic PKD Center. ADPKD Classification. mayo.edu/research/documents/pkd-center-adpkd-classification/doc-20094754
Vasopressin V2 receptor antagonist → reduces cAMP-driven cyst epithelial proliferation and fluid secretion → slows kidney enlargement
3.1% vs 5.5% annual TKV growth; significantly slower eGFR decline over 3 years in CKD Stage 1–3 patients
Confirmed benefit in patients with eGFR 25–65 mL/min/1.73m² (CKD Stage 3–4); slowed decline ~1.3 mL/min/year vs placebo
NHI approved reimbursement for Jinarc in ADPKD patients meeting eligibility criteria — first covered in 2023
Requires pre-approval (事前審查) and annual renewal (申請展延). Administered via hospital NHI portal.
| Criterion | Requirement | Notes |
|---|---|---|
| Diagnosis | Confirmed ADPKD | Imaging or genetic confirmation required |
| Mayo Classification | Class 1C, 1D, or 1E | Derived from height-adjusted TKV (htTKV) via CT imaging |
| Renal Function | eGFR ≥ 25 mL/min/1.73m² | CKD-EPI equation; both cases applied at eGFR 30–35 |
| Liver Function | AST/ALT ≤ 3× ULN, no hepatic disease | Recent lab report required; hepatotoxicity is key concern |
| Ophthalmology | No cataract; IOP within normal limits | Ophthalmology exam report must be attached to application |
| Skin Evaluation | No skin tumors | Clinical documentation in narrative sufficient |
| Metabolic Panel | UA and electrolytes (Na, K) within range | Included in standard lab panel — attach report with date |
Cr, eGFR, AST/ALT, UA, Na/K, CBC, urine PCR — all within 3 months of submission
Abdominal CT → measure TKV + htTKV → determine Mayo class 1C/D/E (within 12 months)
IOP measurement, cataract evaluation — written report required as supporting document
Write clinical narrative with all key elements. Upload via hospital NHI portal (送核) for all 3 dose tiers.
同意備查 — typically 2–7 days. Prescribe and begin titration: 45+15 → 60+30 → 90+30 mg.
Lab Reports (within 3 months)
Imaging, Clinical & Narrative
Three years of continuous treatment — initial application, dose titration, and three successful annual renewals
Demographics
Male, 44 years old ADPKD
Comorbidities
CKD Stage 3 → 4 · Hypertension · Gout
Medications
Aspirin · Carvedilol · Doxazosin · Olmesartan/Amlodipine (Sevikar)
Baseline at Application — Feb 2023
Mayo Classification
Highest-risk group · htTKV > 1,500 mL/m
Feb 23, 2023
Lab workup + CT imaging completed — Cre 2.2, eGFR 35.2, TKV 2,939 mL, htTKV 1,781 mL/m
Apr 24, 2023
Applications submitted for 45+15 mg and 60+30 mg tiers (titration doses)
Apr 25, 2023
Application submitted for 90+30 mg tier (maintenance dose)
Apr 26–28, 2023
All three tiers approved (同意備查) — within 2 to 4 days
May 19, 2023
Jinarc initiated at 45+15 mg → escalated to 60+30 → 90+30 mg over 8 weeks
| Dose Tier | Purpose | Quantity |
|---|---|---|
| 45+15 mg | Titration Week 1–4 | 4 boxes (112 tabs each) |
| 60+30 mg | Titration Week 5–8 | 4 boxes (112 tabs each) |
| 90+30 mg | Maintenance | 5 boxes (140 tabs each) |
Sample Clinical Narrative (translated)
"ADPKD patient. Cre 2.2 mg/dL, eGFR 35.2 mL/min. LFT/UA/electrolytes normal (lab report 2023/02/23). No skin tumors. TKV 2,939 mL, htTKV 1,781 mL/m (CT 2023/02/23). Mayo class 1E. IOP normal (ophtho note 2023/04/24). Request NHI coverage for Jinarc to slow CKD progression. Year 1 plan: 45+15 ×4 boxes, 60+30 ×4 boxes, 90+30 ×5 boxes."
35.2
Baseline 2023
17.3
Recent 2026
← older newer →
2.2
Baseline (mg/dL)
4.1
Recent (mg/dL)
← older newer →
May 2023
Jinarc initiated → titration complete → stable on 90+30 mg
Feb 22, 2024 — 1st Renewal
90+30 mg × 336 tabs submitted & approved Feb 23 — within 1 day
Feb 21, 2025 — 2nd Renewal
90+30 mg × 336 tabs — approved Feb 26, 2025
Jan 22, 2026 — 3rd Renewal
90+30 mg × 336 tabs — approved Jan 27, 2026
Renewal Narrative — Key Elements
Strong family history · larger kidneys · concurrent anemia management alongside Jinarc
Demographics
Female, 44 years old ADPKD
Comorbidities
CKD Stage 4 · Hypertension (onset age 32) · Iron-deficiency Anemia · Gout
Family History
Mother: ADPKD + Hypertension
Brother: CKD · Sister: affected · Father: HTN
Classic autosomal dominant pedigree
Medications
Ferrous · Indapamide · Azilsartan (Edarbi) · Nebivolol
Baseline at Application — Aug 2024
Mayo Classification
htTKV 2,258 mL/m — significantly enlarged
Jul 4, 2024
Abdominal CT confirmed TKV 3,679.8 mL; polycystic kidneys and liver documented
Aug 23, 2024
Full lab workup — Cre 2.2, eGFR 30.8, LFT/UA/electrolytes within normal limits
Aug 29–30, 2024
All three dose tiers submitted simultaneously: 45+15, 60+30, 90+30 mg
Sep 2–4, 2024
All tiers approved (同意備查) within 3 to 6 days
Sep 25, 2024
Jinarc initiated at 45+15 mg → titrated to 90+30 mg over 8 weeks
| Dose Tier | Purpose | Quantity |
|---|---|---|
| 45+15 mg | Titration Week 1–4 | 4 boxes (112 tabs each) |
| 60+30 mg | Titration Week 5–8 | 4 boxes (112 tabs each) |
| 90+30 mg | Maintenance | 5 boxes (140 tabs each) |
Jul 29, 2025 — 1st Renewal
90+30 mg × 336 tabs · approved Aug 7, 2025
37.6
Earliest (2022)
20.4
Recent (2026)
← 2022 2026 →
1.6
Earliest (mg/dL)
2.85
Recent (mg/dL)
← 2022 2026 →
| Feature | Case 1 — Male, 44y | Case 2 — Female, 44y |
|---|---|---|
| Mayo Classification | 1E | 1E |
| TKV at application | 2,939 mL | 3,680 mL |
| htTKV at application | 1,781 mL/m | 2,258 mL/m |
| eGFR at application | 35.2 mL/min/1.73m² | 30.8 mL/min/1.73m² |
| Jinarc started | May 2023 | Sep 2024 |
| Duration / renewals | ~3 years · 3 annual renewals | ~1.5 years · 1 annual renewal |
| Approval time (initial) | 2–4 days | 3–6 days |
| Notable comorbidity | Gout, HTN | Iron-deficiency anemia, HTN, strong FHx |
| Renal outcome | Stable ~2yr on Jinarc; recent CKD stage 4 progression | eGFR decline arrested; stabilized 20–23 |
Submit 45+15, 60+30, and 90+30 mg in the same cycle. Both cases confirm this — all tiers approved together within one week, covering full titration.
All labs must be within 3 months; CT within 12 months. Coordinate lab draw, CT, and ophthalmology in the same clinical window when possible.
Ophtho appointments can have long waits. Book the evaluation in advance — the written report must be available at time of NHI submission.
Include: diagnosis, Cre/eGFR, LFT/UA/electrolyte status, TKV + htTKV, Mayo class, IOP, no skin tumors, and full dose plan. Completeness avoids delays.
No CT required. Submit current dose, start date, recent Cr/eGFR/proteinuria, and a brief stability statement. Consistently approved within 1–7 days.
Case 2 had severe anemia and active gout — neither contraindicated Jinarc. Monitor LFTs closely; address concurrent conditions alongside treatment.
Mayo 1E patients, eGFR 30–35 at application — all NHI tiers approved rapidly. Maintained on 90+30 mg Jinarc long-term.
Case 1: eGFR stable ~33 for 2 years; CT showed no structural progression. Case 2: eGFR decline arrested after treatment initiation.
Pre-approval within 2–7 days when documentation is complete. Annual renewals are straightforward — no CT required, approved in 1–7 days.
Apply all three dose tiers simultaneously. Prepare documentation proactively. A complete narrative = fast approval and seamless titration.
台大雲林分院腎臟科 紀竣議 · Nephrology Division, NTUH Yunlin Branch · June 2026