Changes to cancer treatment insurance coverage and when they will kick in

MediSave withdrawal and MediShield coverage will be limited to drugs and treatments on the Cancer Drug List. PHOTO ILLUSTRATION: PEXELS

SINGAPORE - The cost of cancer treatment has been going up at a much faster pace than other medical treatments.

The MediShield Life Council has reported to the Ministry of Health (MOH) that spending on cancer drugs was increasing at 20 per cent a year, as against 6 per cent for other drugs.

Together with more cancer patients seeking treatments, MediShield Life payouts for outpatient cancer treatments had gone up by more than 50 per cent from $109 million in 2017 to $168 million in 2020.

To rein in the soaring costs, the MOH announced last August that it will allow insurance to only cover effective as well as cost effective drugs and treatments on a newly created Cancer Drug List.

The list will cover 90 per cent of treatments given in public hospitals.

MOH's Agency for Care Effectiveness has said cancer patients account for about 2 per cent of all patients but cancer drugs constitute 35 per cent of public sector drug spending.

It said that on average, 50 per cent of new cancer drugs or newly discovered uses for existing drugs enter the market with no evidence that they improve survival or quality of life.

For the five-year period from 2017 to 2021, this spending increased by 90 per cent to $275 million, while overall national age-adjusted cancer mortality improved by 2.1 per cent.

The agency was set up in 2015 to assess the impact and value of healthcare technology.

From September 2022

MediSave withdrawal and MediShield coverage will be limited to drugs and treatments on the Cancer Drug List.

This list was arrived at with input from cancer doctors in the public and private sectors, and are for treatments that have proven both effective and cost-effective.

Those not on the list cannot be covered.

At the same time, the MOH has changed the amount of cancer coverage by MediShield Life, the compulsory national health insurance.

Instead of a flat rate of up to $3,000 a month, it will cover only the most expensive drug when more than one drug is being prescribed. If it is a combination therapy that is on the list, all the drugs in the combination therapy will be covered with amounts ranging from $200 to $9,600 a month.

The MOH will also raise the ceiling for Singaporeans who can benefit from Medication Assistance Fund (MAF) from a per capita household income of $2,800 to $6,500, with subsidies ranging from 40 to 75 per cent.

With the changes, MOH said close to 90 per cent of subsidised Singaporean patients who use treatments on the Cancer Drug List will have their cancer drug bills fully covered by subsidy and MediShield Life, subject to co-payment which can be paid using MediSave.

From April 2023

The rule about insurance coverage for only drugs and their use that are on the Cancer Drug List will be extended to Integrated Shield Plans (IP).

IP insurers will not be allowed to continue covering patients on treatments that are not on the list.

About 70 per cent of people here have bought IPs that pay for private care. The MOH told The Straits Times that if IPs continue to cover cancer treatments the way they do now, "claims and premiums will increase unsustainably and become unaffordable to many".

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