On 17 August 2021, the Ministry of Health (MOH) announced new changes to outpatient cancer treatments covered under the national MediShield Life scheme. For those of us who are healthy and unburdened by disease, this news may be easily overshadowed by other political and economic news. However, health is something we shouldn’t take for granted. Every Singaporean should be aware of these MediShield Life changes as we are all covered under MediShield Life and the cost of increasing premiums.
Last year, on 29 September 2020, MOH announced the review of MediShield Life as well as the public consultation based on the recommendations of the MediShield Life Council. The changes to cancer treatment are part of the accepted recommendations from the MediShield Life Council.
Cancer Is The Leading Cause Of Death In Singapore
According to MOH data on principal causes of death, about 28% of deaths in 2019 were from cancer and has been consistently the top cause of deaths from 2017 to 2019. This means that there is a one in three chance that we would need to tap on MediShield Life for cancer treatment for ourselves or our loved ones.
As medical treatment advances, more treatments become available at a higher cost. The cost of cancer treatment has increased with the national spending on cancer drugs growing at 20% per year, compared to 6% per year for non-cancer drugs.
The number of MediShield Life claimants for outpatient cancer drug treatments has also increased by almost 30%, from 22,500 in 2017 to 29,100 in 2020. Payouts for outpatient cancer drug treatments have increased by more than 50% from $109 million in 2017 to $168 million in 2020. This is more than double the increase in the overall MediShield payouts during the same period.
This means that the changes to cancer treatment will have a huge impact on our future healthcare costs and the MediShield Life premiums we will have to pay collectively. Here are the changes to outpatient cancer treatments that will be implemented from September 2022
#1 MediShield Life Will Only Cover A List Of Approved Cancer Drug Treatments Instead Of All Cancer Drug Treatments.
Currently, MediShield Life allows patients to claim up to $3,000 per month for all outpatient cancer drug treatments and related services. The claim limit is capped at $3,000 per month.
According to the Council’s report, the current claim approach has the unintended effect of raising cancer drug prices to maximise the claims. Singapore is currently paying higher prices for cancer drugs compared to other regional countries such as Taiwan, South Korea, Australia and New Zealand. Drug manufactures are not incentivised to offer better prices as MediShield Life pays out to the claim limit for all cancer drugs regardless of health benefit or price. Patients and doctors are not also incentivised to seek out cost-effective treatments as such choosing lower cost alternatives such as biosimilars or generics.
From September 2022, MediShield Life will cover a positive list of clinically proven and cost-effective cancer drug treatments, with more granular claim limits ranging from $200 to $9,600 per month to be better aligned to the different costs of cancer drug treatments. This will enable Singapore to negotiate for better drug prices from drug manufacturers and enable better targeted coverage including higher claims limits where the treatment is clinically appropriate and cost effective.
The positive list will be updated every four months. For treatments not included in the list, oncologists can request for evaluation for a treatment to be included on the list if there is sufficient clinical evidence to support their use.
#2 Outpatient Cancer Drug Services Will Have A Separate Claim Limit
Under the new changes, outpatient cancer drug services will have a separate claim limit of $1,200. This will include scans, blood tests and doctor consultations. This means that patients who are on expensive cancer drug treatments (on the positive list) will be able to have their scans, blood tests and consultations covered, instead of using all of their claim on the drug treatment alone.
#3 Medication Assistance Fund (MAF) Subsidies Will Be Extended To More Singaporeans
Currently, subsidised patients with a per capita household income (PCHI) of $2,800 and below are eligible for up to 70% subsidies for drugs listed on the Standard Drug List and the Medication Assistance Fund (MDF). In general, less expensive drugs are listed on the SDL, while more expensive drugs are listed on the MAF where they apply only when prescribed to patients who meet clinical criteria specific to the drug to ensure that their use is cost-effective.
From September 2022, the MAF subsidies will be extended to Singaporeans with PCHI between $2,800 and $6,500 per month.
|Monthly PCHI||Subsidy Tier (Singapore Citizens)|
|$2,000 < PCHI≤$2,800||50%|
|$2,800 < PCHI≤$3,300||0%*||50%|
|$3,300 < PCHI≤$6,500||40%|
|PCHI > $6500||0%*|
* In exceptional deserving cases, MAF may be extended upon appeal.
This will allow more patients to better afford drug treatments and the subsidies will apply to both cancer and non-cancer drugs on the MAF. The new MediShield Life claim limits for cancer drug treatments will be applied on post-subsidy bills.
#4 MediSave Withdrawal Limits Will Be Adjusted
In line with the MediShield Life changes, the Medisave withdrawal limits will be adjusted for cancer drug treatments and services. This will also allow more Singaporeans to pay less out-of-pocket for cancer drug treatment as MediShield Life co-payments can be paid with MediSave.
|MediShield Life||$3,000 per month for all cancer drug treatments and services||Ranges from $200 to $9,600 per month for cancer drug treatments on the positive list.|
|Additional $1,200 per year for cancer drug services.|
|$1,200 per month for all cancer drug treatments and services.||$1,200 per month for cancer drug treatments with MediShield Life claim limit above $5,400, and $600 per month for other treatments on the positive list.|
|Additional $600 per year for cancer scans^.||Additional $600 per year for cancer drug services and/or other cancer scans^.|
#5 Integrated Shield Plan Coverage Will Only Be Required To Cover Treatments On The Positive List
Currently, most Integrated Shield Plans (IPs) cover outpatient cancer drug treatments on an as-charged basis, up to an overall policy year limit. To encourage the use of clinically proven and cost-effective cancer drug treatments, IPs will be required to only cover treatments on the MediShield Life positive list and set claim limits for each cancer drug treatment. To help IP providers transit, these changes will apply to all IPs sold or renewed from April 2023 onwards.
However, IP riders which are fully paid with cash and not MediSave, will not be affected by these changes. This leaves an option for those who are willing to pay more to obtain additional coverage for cancer drug treatments. IP policyholders may continue to purchase riders to ensure that they have coverage for all cancer treatments.
Close To 90% of Subsidised Patients Will Have Their Cancer Drug Bills Fully Covered By The New Changes
Under the new changes, close to 90% of subsidised Singaporean patients who use these treatments will have their cancer drug bills fully covered by subsidy and MediShield Life, subject to co-payment which can be paid using MediSave. This is an improvement from the current system where 70% of all subsidised Singaporean patients on cancer drug treatments have their bills fully covered.
Additionally, the changes only apply for outpatient cancer drug treatments, inpatient cancer drug treatments are covered separately under the inpatient claim limits, together with other costs incurred during the inpatient stay. As part of the MediShield Life review, the claim limits for daily ward and treatment charges have been raised to $1,000 per day for the first two days and $800 per day for the third and subsequent day of normal ward stay, and the MediSave withdrawal limit is $550 for the first two days and $400 for the third and subsequent day of the ward stay.
For most Singaporeans, the changes are positive as they would reduce the overall cost of healthcare at a national level and at the individual bill level.
For example, a middle-income Singaporean would be eligible for the 50% MAF subsidy. Based on a scenario of a middle-income Singaporean with breast cancer on a drug regime of one high-cost drug and one-cost drug, she would expect to pay less overall with the full amount payable with Medisave.
Additionally, with better price negotiations with drug manufacturers, more drugs are expected to become cost-effective. 55 more cancer drugs are expected to be listed under the SDL/MAF, which will increase support for around 150 cancer drug treatments. This will ease the cost burden on patients who are currently capped by the $3,000 claim limit and make cancer drug treatment more affordable. The separate claim limit for cancer drug services also means that they are more fully covered for both treatment and services.