What determines whether a drug is subsidised?

There should be a focus on inclusion over exclusion when determining drug subsidies, especially for drugs regarded as mainstream for chemotherapy.
There should be a focus on inclusion over exclusion when determining drug subsidies, especially for drugs regarded as mainstream for chemotherapy.PHOTO: REUTERS

Mr Tham Zhi Qian's experience of not being told about the Medication Assistance Fund (MAF) available for members of the Pioneer Generation is unfortunately not a one-off case (Public should be aware of available medical subsidies, Feb 20).

The patient service staff at the hospital where my father is currently being treated for cancer did not mention the scheme, even after I asked why there was no subsidy available for the chemotherapy drug Methotrexate used to treat him.

I was told only that a non-standard drug had been dispensed, and that I should ask the relevant authorities why it was not subsidised.

According to the Ministry of Health's website, Methotrexate is actually subsidised as a standard drug in various forms such as tablet and injection, but not in the form of concentrate for solution for infusion which was prescribed by my father's team of doctors.

The basic lexicon on chemotherapy that I have checked in recent weeks all cite Methotrexate, as well as adjunctive drugs such as Rituximab often used in combination with it to mitigate its side effects, as a pretty standard item for treatment.

So why is Methotrexate subsidised only in certain forms, and Rituximab subsidised only in concentrate for infusion form under MAF and subject to means-testing even for Pioneer Generation members like my father?

Surely there should be a focus on inclusion over exclusion when determining drug subsidies, especially for drugs regarded as mainstream for chemotherapy.

I hope the relevant authorities, including the Drug Advisory Committee, can shed some light on this.

Too much focus has been placed on the supply side of rising healthcare costs, and too little on the demand side.

A recalibration is long overdue for the future of sustainable and high-quality healthcare.

Toh Cheng Seong

A version of this article appeared in the print edition of The Straits Times on February 26, 2019, with the headline 'What determines whether a drug is subsidised?'. Print Edition | Subscribe