Cancer Treatment Singapore: Upcoming Changes to Cancer Drug Treatments Insurance Coverage You Need to Know
What Is the Leading Cause of Death in Singapore?
Here’s a statistic for you.
According to the latest data from the Ministry of Health (MOH), the leading cause of death in Singapore is cancer, with the disease accounting for ~6,308 or 28.6 per cent of all deaths in Singapore in 2020:
According to the Health Promotion Board (HPB), ‘about 1 in every 4 to 5 Singapore residents, male or female, is likely to develop cancer in his or her lifetime.’
The good news is that you can have better clinical/management outcomes with early detection and treatment.
Granted, cancer treatment is not affordable, as treatment of cancer per month is estimated to be between $8,000 to $17,000 a month without insurance coverage.
With all this in mind, I think that all Singapore residents should sit up and note that in a few months, MOH will be implementing new rules around insurance coverage for outpatient cancer treatment costs.
More specifically, insurance will generally only cover cancer treatment drugs approved by the Government.
Here is all you need to know!
TL;DR: Cancer Treatment Cost in Singapore — Upcoming Changes to Coverage for Outpatient Cancer Drug Treatments
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Why is MOH Making These Changes to Insurance Coverage for Cancer Drugs?
So here’s the thing.
The cost of cancer drugs in Singapore was getting a bit out of hand.
spending on cancer drugs (in Singapore) has been growing at a Compound Annual Growth Rate (CAGR) of 20%, far exceeding the 6% CAGR for non-cancer drugs.
Cancer drugs accounted for one-quarter of total drug spending in 2019, at $375 million. If this current trajectory continues, cancer drug spending is projected to reach $2.7 billion in 2030.
In response, the council appointed a Cancer Drug committee comprised of private and public sector oncologists to review MediShield Life’s coverage of cancer drug treatments.
The committee then recommended that the MOH put together a list of economical outpatient cancer drug treatments covered under MediShield Life.
The Government has since accepted the council’s recommendations and will:
- Create a list of clinically proven and cost-effective outpatient cancer drug treatments
- Allow these cancer drug treatments to be claimable under MediShield Life
- Set more granular claim limits to provide better coverage based on the cost of each treatment.
For what it’s worth, these recommendations are similar to what developed countries like South Korea, Australia and the UK have implemented.
If implemented, Singapore will be able to negotiate better prices for these cancer drugs, which in turn will help curb increases in MediShield Life premiums.
MOH-Approved Outpatient Cancer Treatment Drug List
Based on the MediShield Life Council’s recommendation, the MOH has developed this Cancer Drug List of 278 or so economical and clinically proven cancer drug treatments.
This is a list of MOH-approved outpatient cancer treatment drugs and the type of cancer they are approved to treat.
This list will also be updated every four months to keep up with advancements in medicine.
Already, this list covers about 90 per cent of the cancer treatments in the public sector and includes some commonly used treatments that are not as clinically proven or economical but have been exempted from this exclusion.
And from September 2022, the MOH will be limiting the basic MediShield Life insurance coverage to the cancer drug treatments on this list.
In addition, these limits will also apply to the withdrawal of MediSave funds.
Concurrently, the Government will be raising the eligible income criteria for Medication Assistance Fund (MAF) subsidies so that more Singaporeans will benefit.
Not to mention that they will be subsidising more cancer drug treatments as well.
Changes to MedisSave Withdrawal Limits for Cancer Treatment in Singapore
On top of the changes to MediShield Life coverage for cancer treatments that take effect from September 2022, there will be changes to the MediSave withdrawal limits for outpatient cancer scans and outpatient chemotherapy treatment too:
(Before September 2022)
(From September 2022)
|MediShield Life||$3,000 per month for all cancer drug treatments and services||Ranges from $200 to $9,600 per month for cancer drug treatments on the positive list
Additional $1,200 per year for cancer drug services
|MediSave||$1,200 per month for all cancer drug treatments and services|
Additional$600 per year for cancer scans.^
|$1,200 per month for cancer drug treatments with MediShield Life claim limit above $5,400, and $600 per month for other treatments on the positive list
Additional $600 per year for cancer drug services and/or other cancer scans.^
^ MediSave can also be used for scans for post-treatment monitoring and radiotherapy patients
Also, the new MediShield Life claim limits for cancer drug treatments will be set based on post-subsidy bills.
Changes to Medication Assistance Fund (MAF) Subsidies For Cancer Treatment in Singapore
According to the MOH, public healthcare patients receive up to 75 per cent subsidy for cancer drugs that fall under the Standard Drug List (SDL) and MAF list.
The ministry added that following price negotiations with drug manufacturers to achieve better drug prices and cost-effectiveness, 55 more cancer drugs will be listed under the SDL/MAF, which will increase support for around 150 cancer drug treatments.
Moreover, the Government will be raising the eligible income criteria for MAF subsidies so that more Singaporeans will benefit. Subsidies of up to 50 per cent will be extended to Singaporeans with per capita household income (PCHI) between $2,800 and $6,500 per month:
FYI: PCHI is calculated by taking the total gross household monthly income divided by the total number of family members living together.
|Monthly Per Capita Household Income (PCHI)||Subsidy Tier (Singapore Citizens)|
|$2,000 < PCHI≤$2,800||50%|
|$2,800 < PCHI≤$3,300||0%*||50%|
|$3,300 < PCHI≤$6,500||40%|
|PCHI > $6500||0%*|
*In exceptional deserving cases, MAF may be extended upon appeal.
One more thing, this MAF subsidy enhancement applies to both cancer and non-cancer drugs on the MAF list. This means that eligible patients will get to enjoy more affordable treatment.
Impact of Changes on Integrated Shield Plans (IPs)
That’s not all.
From April 2023, the Cancer Drug List framework will also apply to Integrated Shield Plan (IP) coverage.
This means that if you bought an IP from private insurers, your IP might not cover cancer drugs not on the list from April 2023, as IPs will be required to only cover treatments on the MediShield Life Cancer Drugs List and set claim limits for each cancer drug treatment.
In addition, MOH announced on 17 August 2021 that the framework will apply to all IPs renewed or sold from April 2023.
This is a marked change from the status quo as most IPs provide as-charged coverage for outpatient cancer drug treatments, subject to an overall policy year limit which could exceed $2 million.
However, these changes do not affect IP riders, which are paid for wholly in cash.
What About Those Who Have Difficulties Paying For Cancer Drug Treatments?
Singaporeans who face difficulties paying for cancer drug treatments and related services after subsidies, insurance and MediSave can apply for MediFund for further assistance.
Concluding Thoughts and Concerns
Granted, the implementation of the approved Cancer Drug List framework and the fine-tuning of granular claim limits to provide better coverage based on the cost of each treatment will go some way to improve the affordability of cancer drug treatments.
But, according to a recent Straits Times report, the 12 or so oncologists interviewed raised concerns that the new framework might affect the care that cancer patients can receive, especially for those suffering from cancers that are not as common.
The Singapore Society of Oncology added in a statement that:
In settings where there is no robust data, doctors often need to make treatment decisions for their patients based on clinical judgment – this is where we wade into the waters of ‘off-label’ prescribing.
Also, the new rules have caused “a fair amount of discomfort and unease among doctors” and “it feels as if the doctors’ prescribing wings have been clipped”.
FYI: The National Cancer Institute of America defines an off-label drug as ‘the practice of prescribing a drug for a different purpose than what was approved by the regulatory body. This practice is called “off-label” because the drug is being used in a way not described on its package insert. This insert is known as its “label.”‘
This off-label practice is pretty common with several diseases but more prevalent in oncology.
However, a February 2017 study published in the Journal of Clinical Pharmacy and Therapeutics pointed out that:
the suitability of anticancer medications for off-label use remains controversial due to uncertainty around the clinical benefits and potential toxicities, limited evidence to support clinical decision-making, increased out-of-pocket costs for patients and ethical concerns around the lack of informed consent.
What Are Your Thoughts on the New Cancer Drug List Framework?
Do share your thoughts with the Seedly community!