In brief
On 2 September 2022, the Singapore Ministry of Health (MOH) announced that additional transitional support will be provided to cancer patients with changes introduced to the financing regime of cancer drugs.
To enhance the sustainability of cancer drug spending, the MOH had previously, in August 2021, established a Cancer Drug List (CDL) of clinically proven and more cost-effective treatments, accompanied with changes to MediShield Life, MediSave and Integrated Shield Plan (“IP“) coverage.
Subsidies of clinically effective and cost effective cancer drugs will, with effect from 1 September 2022, be extended through the Medication Assistance Fund at Public Healthcare Institutions.
Additional transitional support will also be implemented to cushion the impact of cancer drug spending for patients with IPs that currently cover their treatments and patients with MediShield Life only.
Key takeaways
With the introduction of more subsidies and incentives for patients to use drugs on the CDL, the Singapore government is now better placed to negotiate better prices for cancer drugs, as cancer drug companies may wish for their cancer drugs to be included on the CDL.
The additional transitional support provided would also allow close to 90% of the subsidised patients to have their bills in relation to cancer treatments almost fully covered by subsidies and MediShield Life.
In more detail
Background
In Singapore, the cancer drug financing regime mainly consists of four pillars: (i) direct government subsidies (through schemes like the Medication Assistance Fund), (ii) MediSave (a compulsory individual medical savings account scheme), (iii) MediShield Life (a basic health insurance plan for Singaporeans and Permanent Residents), and (iv) IP (an optional health coverage provided by private insurance companies).
Amidst rising costs for cancer drug therapies, a Cancer Drug Committee (“Committee“) was appointed to ensure the long term sustainability of drug financing. Having reviewed the financing regime of cancer drugs in other countries, the Committee observed that national funding schemes tend to only cover drugs that meet the requisite standards of safety, quality and efficacy and that are cost-effective. In other words, drugs that are not cost-effective would not receive any funding.
Overview of CDL and revisions to the cancer drug financing regime
The CDL is a “positive list” that includes clinically proven and cost-effective cancer drug treatments. If the treatments’ health benefits are not clinically proven or if they are not cost-effective at the price, they will not be included on the positive list.
As of 1 September 2022, more than 90% of cancer drug treatments that are approved by the Health Science Authority are listed on the CDL. About two-thirds of the treatments found on the CDL are subsidised. The CDL and its corresponding subsidy levels and claim limits will be regularly reviewed (once every few months) to ensure that they are in line with the latest clinical advancements. Apart from the introduction of the CDL, there are several changes to the cancer drug financing regime.
First, subsidies are now extended to Singapore citizens with per capita household income (PCHI) between SGD 2,800 and SGD 6,500. Previously, Singaporeans with PCHI below SGD 2,000 are eligible for 75% of subsidies and those between SGD 2,000 and SGD 2,800 are eligible for 50%. Now, the subsidies have been extended to Singaporeans with higher PCHI, as seen in the following table:
| Revised Coverage (from 1 September 2022) | ||
| Drug subsidies for Singaporeans (for drug indications under the Medication Assistance Fund) | PCHI | Subsidy |
| PCHI ≤ SGD 2,000 | 75% | |
| SGD 2,000 < PCHI ≤ SGD 3,300 | 50% | |
| SGD 3,300 < PCHI ≤ SGD 6,500 | 40% | |
| PCHI > SGD 6,500 | 0% |
Second, there are also changes made to the withdrawal limits for MediSave and MediShield Life. For MediShield Life, the previous limit of SGD 3,000 per month has been revised to a limit of SGD 200 – SGD 9,600 per month for cancer drug treatments on the positive list. There is also an additional SGD 1,200 per year for cancer drug services.
For MediSave, the limit of SGD 1,200 per month has been revised to a limit of SGD 1,200 a month for cancer drug treatments with MediShield Life claim limit above SGD 5,400, and SGD 600 per month for other treatments on CDL. There is also an additional SGD 600 per year for cancer drug services and/or other cancer scans.
Transitional support
MediShield Life and MediSave will only cover treatments on the CDL from 1 September 2022.
IP coverage will only be changed to cover treatments that are on CDL from 1 April 2023 onwards, when an existing policy is renewed or a new policy is purchased. For IPs that are renewed between 1 April 2023 and 30 September 2023, insurers have committed to preserving the current IP coverage until 30 September 2023. As for riders, these will not be affected and will cover treatments beyond the CDL.
Patients without an IP, and who had started treatments that are unsubsidised or not on the CDL before 1 September 2022 will receive additional financial assistance.
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The greater subsidies and increased transitional support incentivises the use of cancer drugs on the CDL, and serves as an impetus for drug companies to find ways to enhance the cost-effectiveness of their drugs so that their drugs may be included in the CDL.
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