Forum: Assistance available for cancer patients who need medications not on new list

We refer to senior health correspondent Salma Khalik's commentary, "Rules on cancer treatment financing can be improved" (June 13), and subsequent Forum letters on the topic.

To ensure cancer treatments remain affordable for most Singaporeans, where possible, we focus government subsidies, MediShield Life and Integrated Shield Plans to cover clinically proven and cost-effective treatments on a new Cancer Drug List. Around 90 per cent of cancer drug treatments used in public healthcare institutions are on the Cancer Drug List.

Should financing coverage be liberally extended to very expensive and novel cancer drugs, treatment costs will inevitably rise along with insurance premiums. This will make it less affordable for the broad masses.

Encouragingly, our latest policy has incentivised pharmaceuticals to reduce prices of cancer drugs by 30 per cent on average in order to benefit from subsidies, MediShield Life and Integrated Shield Plan coverage. This will benefit many patients and improve affordability of more cancer drugs for all Singaporeans.

Some patients use off-label cancer drugs. This means using a drug that has not been approved by the Health Sciences Authority for that purpose, usually because there is insufficient clinical evidence to ascertain their safety and efficacy.

We understand that at times, off-label drugs may provide much-needed hope for patients and their loved ones. Hence oncologists are allowed to prescribe such drugs, but without subsidies, MediShield Life or Integrated Shield Plan coverage. We also hope patients weigh the risks and costs with their doctor and insurer to make an informed decision.

Nevertheless, it is not impossible for off-label drugs to be covered by insurance and assistance. There are private insurance schemes that cover off-label cancer drugs. Subsidised patients who are assessed by public healthcare institutions to require non-Cancer Drug List treatments and face difficulty affording these may apply for MediFund and Medication Assistance Fund Plus, or appeal to use more MediSave.

The Ministry of Health will also facilitate referrals of private patients to subsidised care, to let them access such institution-based financial assistance.

Where combination cancer drug therapies are required, indeed patients will be able to claim up to the limit for the higher-cost drug on the Cancer Drug List. As many of the low-cost drugs are subsidised under the new policy, the treatment cost should remain affordable.

Where more than one high-cost drug is needed, and such combination therapies have been assessed to be clinically proven and cost-effective, a higher claim limit will be provided.

Lydia Loh
Director (Finance Policy)
Healthcare Finance Division
Ministry of Health

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