I refer to the reports "Doctors concerned over curbs on outpatient cancer treatment cover" and "How the drugs list might impact you" (both published on June 10) and "Rules on cancer treatment financing can be improved" (June 13).

The new Cancer Drug List contains only clinically proven cancer drugs that are also cost-effective. However, this is not so straightforward.

Some drugs are proven but may not be cost-effective.

For instance, chimeric antigen receptor T-cell therapy is a novel treatment that can cost up to US$475,000 (S$660,000). It is considered effective. But would the insurance companies consider it cost-effective?

I have survived two bouts of lymphoma.

The first time, my oncologist recommended a cheap, off-label drug, based on his experience.

It was cost-effective, but other practitioners told me there was no evidence that it would work, as pharmaceutical companies would not conduct trials for it because it would not be profitable for them to do so.

The new rules also state that patients who require more than one drug will get insurance coverage only for the more expensive drug.

But a cocktail of drugs is often needed for chemotherapy to work, not to mention to alleviate the debilitating side effects.

Patients who cannot afford to pay would have to endure without the medication. Those who cannot endure it might give up the treatment.

Cancer treatment also does not comprise pharmaceuticals alone. There are operations, scans and numerous other investigations.

I have had to see a gastroenterologist and an ear, nose and throat expert following chemotherapy. These have been expensive. Has the Ministry of Health considered the costs and pricing of the pharmaceutical companies and medical service providers as part of its analysis?

Patients will receive a reduction in benefits from these new rules while insurance companies will receive cost savings. What is being done to ensure these are passed on in the form of premium reduction?

Will another rider be introduced to charge cancer sufferers more for off-label treatment? Insurance policies have enough fine print already.

Off-label medication is often the last resort as the oncologist runs out of options and other treatments have failed.

Patients are desperate as they fight for their lives. Restricting access to these drugs risks taking away their only chance of survival.

How many proven drugs are waiting to become cost-effective? How many inexpensive but rare treatments are precluded because they are not profitable to test? How many lives are lost in the interim?

Healthcare cannot be a numbers game. What price do you put on a human life?

Charlie Ransford