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Cancer treatment to be more affordable under changes to Medishield Life and other schemes: MOH

SINGAPORE — Upcoming changes to some healthcare schemes here will mean close to 90 per cent of subsidised cancer patients using specified drugs will have their cancer drug bills fully paid by subsidy and MediShield Life. This will be subject to co-payment, which can be paid using MediSave.

Among various changes, the Ministry of Health will subsidise more cancer drug treatments and extend Medication Assistance Fund subsidies to more Singaporeans by raising the eligible income criteria.

Among various changes, the Ministry of Health will subsidise more cancer drug treatments and extend Medication Assistance Fund subsidies to more Singaporeans by raising the eligible income criteria.

  • MOH said that the claims for outpatient cancer drug treatments have been growing at a fast pace
  • MediShield Life Council appointed a Cancer Drug Committee late last year to review how cancer drugs can be covered in a more cost effective manner
  • A set of recommendations from the council were accepted by the Government and will lower the costs of cancer treatment
  • MOH said the recommendations will also allow them to negotiate for better drug prices and improve affordability for more patients

 

SINGAPORE — Upcoming changes to some healthcare schemes here will mean close to 90 per cent of subsidised cancer patients using specified drugs will have their cancer drug bills fully paid by subsidy and MediShield Life. This will be subject to co-payment, which can be paid using MediSave.

The firgure is up from 70 per cent of such patients now, the Ministry of Health (MOH) said.

In an announcement on Tuesday (Aug 17), the ministry said that changes to Medishield Life coverage, for instance, will reduce the cost of some cancer drug treatments.

This will be done through the creation of a “positive list” of clinically proven and cost-effective cancer drug treatments that can be claimed under the insurance plan, and more granular claim limits.

MediShield Life is a basic health insurance plan for Singapore cistizens and permanent residents. It is administered by the Central Provident Fund (CPF) Board and helps to pay for large hospital bills as well as selected costly outpatient treatments such as dialysis and chemotherapy for cancer.

Aside from the above, MOH will subsidise more cancer drug treatments and extend Medication Assistance Fund subsidies to more Singaporeans by raising the eligible income criteria.

The Medication Assistance Fund is a scheme set up by MOH to help patients who face difficulty in paying for selected high-cost medications for certain medical conditions, including some cancer drugs.

These latest changes came after the Government accepted a set of recommendations from the MediShield Life Council, which had set up a committee to look into the high cost of cancer care.

To allow enough time for existing patients to complete their current course of treatment and adjust their treatment plans if needed, the changes will take effect only in September next year.

Separately, adjustments to Integrated Shield Plan (IP) coverage will take effect in April 2023, to give insurers more time to make the necessary changes.

IPs consist of a MediShield Life component managed by the CPF Board and the other, by private insurers.

MOH said that these changes will not affect insurance premiums for Medishield Life at the moment, though this may be subject to change after the next round of reviews in 2024.

However, insurers will have to assess how these changes will affect their cost structures and, consequently, how they may affect IP premiums.

Here is what you need to know about the revisions.

CANCER ON THE RISE

MOH said that MediShield Life claims for outpatient cancer drug treatments have been growing at a fast pace.

Last year, for example, there were some 29,100 claimants, which was a 30 per cent increase from 2017.

Over this same period, the ministry saw more than a 50 per cent increase in MediShield Life payouts to S$168 million.

MOH attributed this growth to rising cancer prevalence and the higher cost of new cancer drug treatments. Between 2013 and 2017, there were 71,748 newly diagnosed cancer cases here.

To review the coverage of cancer drugs, so that they can be covered in a more sustainable manner, the MediShield Life Council appointed a cancer drug committee late last year comprising senior oncologists from the public and private sectors.

MEDISHIELD LIFE CHANGES

At present, patients may claim up to S$3,000 a month under MediShield Life for all outpatient cancer drug treatments and related services.

MOH said that this has the unintended effect of raising cancer drug prices to maximise the claims.

Under the revisions, MediShield Life will pay only for a "positive list" of clinically proven and cost-effective cancer drug treatments.

The ministry said that about 90 per cent of the existing cancer drug treatments used in the public sector will be included in the “positive list”.

This may include treatments that are common today but are not registered with the Health Sciences Authority or are not cost-effective, it added.

The remaining 10 per cent of existing cancer drug treatments not included in the list are excluded mainly due to low clinical need, MOH said.

Infographic: Anam Musta'ein/TODAY

Claims will also range between S$200 and S$9,600 a month to be better aligned to the different costs of cancer drug treatments.

There will be a separate claim lmit of S$1,200 a year for cancer drug services such as scans, blood tests and doctor consultations.

Dr Tan Yew Oo, the chairman of the cancer drug committee and member of the MediShield Life Council, said that the current claim limit of S$3,000 a month is “quite blunt and does not incentivise drug manufacturers to offer better prices or encourage the use of clinically proven and cost-effective treatments”.

 Mrs Fang Ai Lian, chairman of the MediShield Life Council, said that focusing on clinically proven and cost-effective cancer drug treatments will enable Singapore to “negotiate for better drug prices and improve affordability for more patients”. 

MEDISAVE WITHDRAWAL LIMIT CHANGES

MOH said that the CPF MediSave withdrawal limits for outpatient chemotherapy and outpatient cancer scans will have to be adjusted in tandem with the MediShield Life changes.

For now, S$1,200 can be withdrawn a month from MediSave for all cancer drug treatments. Patients may also use an added S$600 a year for cancer scans.

Under the changes, the monthly withdrawal limit will be set at S$1,200 for cancer drug treatments with a MediShield Life claim limit above S$5,400, or S$600 for other treatments on the positive list.

Another S$600-a-year limit will also apply for cancer drug services and other cancer scans including those done during a post-treatment monitoring period.

MEDICATION ASSISTANCE FUND CHANGES

Right now, subsidised patients in public healthcare institutions receive a subsidy of up to 75 per cent for drugs under the Standard Drug List and the Medication Assistance Fund.

MOH said that 55 more cancer drugs will be added to this list, which will increase support for around 150 cancer drug treatments.

Singaporeans with a per capita household income (household income for each person) of more than S$2,800 and up to S$6,500 are now not eligible for any subsidies.

Under the revised Medication Assistance Fund, those within the S$2,801 and S$3,300 income band will receive a subsidy of 50 per cent.

The subsidy for those within S$3,301 and S$6,500 band is slightly lower at 40 per cent.

No subsidy will be given to those who have a per capita household income of more than S$6,500, except under exceptional cases.

MOH said that the subsidy enhancement will apply to both cancer and non-cancer drugs listed on for the Medication Assistance Fund.

Infographic: Anam Musta'ein/TODAY

HOW CHANGES WILL IMPROVE AFFORDABILITY

To illustrate how the changes will affect Singaporeans, MOH cited an example of a middle-income Singaporean patient with breast cancer using a combination of high- and low-cost drugs for treatment. The current costs without subsidy would be S$3,130.

A government subsidy of S$10 would be extended to the low-cost drug because the high-cost drug is not cost-effective at current prices

MediShield Life would pay S$2,805, which leaves a co-insurance of S$315 which can be covered by MediSave.

In contrast, the revisions will see the cost of the drugs drop to S$1,785 without subsidies. This drop in costs will be a result of negotiations with manufacturers for a better price on the high-cost drugs.

And because this high-cost drug is now considered cost-effective, a bigger subsidy of S$890 can be given.

MOH said that MediShield Life will fully cover the post-subsidy bill, subject to a 10 per cent co-insurance of S$95, which is fully payable by MediSave.

INTEGRATED SHIELD PLAN COVERAGE CHANGES

Currently, most IPs provide as-charged coverage for outpatient cancer drug treatments, subject to an overall policy-year limit, MOH said.

To ensure that IPs are aligned in encouraging the use of clinically proven and cost-effective cancer drug treatments, they will be required to cover only treatments that are on the MediShield Life positive list and set claim limits for each cancer drug treatment.

These changes do not affect IP riders, which are paid for fully in cash.

These changes will apply to all IPs sold or renewed from April 2023 onwards, MOH said.

Related topics

MOH cancer medicine MediSave medishield life insurance Integrated Shield Plan

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