Integrated Shield Plans will no longer offer ‘as charged’ cancer coverage from April 1

Those who are already being treated for cancer will have their current coverage extended for six months. PHOTO ILLUSTRATION: UNSPLASH

SINGAPORE - From April 1, Integrated Shield Plans (IPs) will pay up to a maximum of five times the amount of coverage for cancer treatments that the basic MediShield Life does.

This is lower than the current coverage by insurers, most of whom foot policyholders’ bills “as charged” with the usual deductible and co-payment borne by patients.

This change will apply to all policyholders from the time they renew their IP contract. From what the seven IP insurers indicate, their coverage will be from April 1, and the maximum amount will apply to all plans, regardless of whether they are pegged at public sector B1 or A class wards, or private sector care.

Those who are already being treated for cancer will have their current coverage extended for six months to allow them to complete their regimen.

This is the second phase of the move by the Ministry of Health (MOH) to slow the spiralling cost of cancer treatments here – which has been growing at 20 per cent a year – and to obtain better pricing for cancer drugs. The first phase started in September 2022 and affected people who are on only the basic MediShield Life.

MOH said it hopes these changes “will keep cancer treatments and insurance premiums affordable in the longer term”.

There are two parts to the changes.

The first restricts insurance coverage to only cancer treatments on the Cancer Drug List. According to MOH, about 90 per cent of cancer drug treatments approved for use by the Health Sciences Authority, which regulates the use of medication here, are on this list.

Only drugs that have been clinically proven to be effective as well as provide value for money are included. Health Minister Ong Ye Kung has said that if pharmaceutical companies are willing to reduce the price of their drugs so they do provide good value, those drugs would also be added to the list.

As a result of this move, cancer drug prices have dropped by an average of 30 per cent for the public sector, with some falling by as much as 60 per cent. This has so far not been reflected in the private sector.

The second change involves splitting the insurance coverage of cancer care into drugs and services.

For MediShield Life, the amount that drugs can be covered by insurance ranges from $200 to $9,600 a month, depending on the drug used. For IPs, coverage at five times would come to a maximum of $1,000 to $48,000 a month.

The insurance can pay for only the most expensive drug used when more than one drug on the Cancer Drug List is prescribed. If it is a combination therapy that is on the list, all the drugs in the combination will be covered up to the $9,600 a month cap.

For cancer services, MediShield Life pays up to $1,200 a year now. This will be raised to $3,600 from Saturday, a change made by the MOH in response to feedback since the scheme was launched in September 2022 that $1,200 was too low to cover the costs for significant numbers of subsidised patients.

Cancer services include everything other than drugs, such as consultation fees, tests and supportive drugs that treat nausea or infections caused by the treatment.

Patients on IPs will be covered up to a maximum of $18,000 a year, or about $1,500 a month.

Oncologists in private practice, whose patients will be the most affected by the changes, are concerned that the coverage would not be enough unless the patients have also bought riders to cover a large part of their portion of medical bills – that is, the compulsory deductible and co-payment.

About one in three of the 2.9 million people here with IPs, or slightly more than 70 per cent of Singaporeans and permanent residents, do not have riders.

One oncologist said the MediShield Life coverage of drugs is based on the heavily subsidised prices at public hospitals. Five times that might not be enough as the private sector is not able to buy such medicines at the same price as public institutions, which purchase collectively in large amounts.

The MediShield Life claim limits for cancer drug treatments is based on post-subsidy bills. Subsidised patients in the public healthcare institutions receive up to 75 per cent subsidy for drugs that are on the Standard Drug List, or for more expensive ones on the Medication Assistance Fund.

Another doctor said patients’ regimens differ. Most follow a three-week regimen, so there will be some months when they might need to claim as much as double. But the claims limit is fixed per month.

Yet another oncologist is worried that while the IP insurance will likely be enough for straightforward cases with no complications, patients whose cancers have spread beyond the original site and who may require more intense or complex treatments may find themselves facing bill shock.

This is especially since insurance may no longer cover all drugs that such patients may need. He said: “Private IP holders without riders will have difficulty accessing private healthcare which they have dutifully paid for all their lives.”

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