Cancer treatment is not a topic that most people think about. However, cancer was the leading cause of death for 26.4% of total deaths in Singapore in 2021. According to the Singapore Cancer Registry, breast cancer was the leading cause of cancer death for women while lung cancer was the leading cause of cancer death for men. Additionally, as cancer survival rates increase, more people survive the incidence of cancer, which means more than 1 in 4 Singaporeans will be affected by cancer at some point in their lives.
With such statistics, Singaporeans cannot afford to be unaware of the MediShield Life changes to cancer treatment which has been implemented from 1 September 2022.
Cancer Drug List Affects Patients Covered By MediShield Life And Integrated Shield Plans
From September 2022, MOH introduced the Cancer Drug List (CDL) that determines the positive list of clinically proven and cost-effective cancer drug treatments covered by MediShield Life. Effectively, MediShield Life and MediSave only cover treatments on the CDL from 1 September 2022.
For Integrated Shield Plans (IPs), the CDL only came into effect from 1 April 2023 onwards, when an existing policy was renewed or a new policy purchased. For patients with an IP that was renewed between 1 April 2023 and 30 September 2023, and are on a course of cancer drug treatment as of 31 March 2023, insurers have committed to preserve their current IP coverage until 30 September 2023.
For patients who were not covered under CDL (about 10% and 5% of patients in private and public healthcare respectively), most of them continue to be covered under IP. Based on the typical duration of cancer treatment, most patients would have completed their treatment with non-CDL drugs by 30 September 2023.
The Introduction Of The Cancer Drug List Has Reduced The Prices Of Cancer Drugs By 30% On Average
To qualify for inclusion in the CDL, suppliers will need to ensure that the prices justify the effectiveness of the treatment. Once in the CDL, the treatment will benefit from government subsidy and healthcare insurance claims.
According to MOH, since implementing the changes, prices of drugs in the CDL have lowered by 30% on average and in some cases, by over 60% for some drugs. More drugs have been included in the CDL as more suppliers reduce their prices. Since the first publishing of the CDL in August 2021, the number of treatments in the CDL has increased from 270 to 340, as of 1 February 2023. In total, this covers about 90% of all HSA-approved treatments.
About 90% of patients in private medical institutions and about 95% of patients in Public Healthcare Institutions were on CDL treatments over the period of 1 September to 31 December 2022, according to MOH. Thus, most patients are unaffected by the change and will even benefit from the lower cost of drugs.
A Drug On The Cancer Drug List May Not Be An Approved Cancer Treatment
Aside from the type of drug, the CDL also includes the approved subsidy class and prevailing MediShield Life and MediSave limits. For example, a brand of an active ingredient may be eligible for SDL subsidy but other brands of the same active ingredient may not be eligible for SDL subsidy but qualify for MediShield Life, MediSave and IP coverage.
Additionally, what most people may not realise about the Cancer Drug List is that it does not only determines the drugs covered under insurance but also the type of treatment. Only indicated cancer treatments are covered.
For example, if a drug is used for another CDL-approved cancer treatment but not recommended for your specific cancer, it is not covered under the CDL and is not eligible for insurance coverage.
If more than one cancer drug from the list is used in a month, the patient may claim up to the amounts not exceeding the highest MediShield Life and MediSave claim limits applicable for the individual drugs. For example, if a patient uses both Drugs A (MediShield Life claim limit of $2,000 & MediSave withdrawal limit of $600) and B (MediShield Life claim limit of $1,000 & MediSave withdrawal limit of $600) in a month, the patient may claim no more than $2,000 from MediShield Life and $600 from MediSave in that month.
If Your Cancer Treatment Is Not Covered Under CDL
For existing cancer patients whose treatments extend beyond 30 September 2023, MOH has suggested a few possibilities:
- Currently excluded treatments may become included as the CDL continues to expand. The CDL will be continually updated every 4 months.
- Doctors and patients may also consider shifting towards CDL treatments that are clinically proven and more cost-effective.
- Patients who require non-CDL treatments and face affordability issues may opt for subsidised care at Public Healthcare Institutions, where they may apply for additional support such as MediFund.
- Patients who continue with non-CDL treatments may still be covered by private insurance products such as IP riders or critical illness plans that they previously purchased.
As the private insurance coverage of non-CDL treatments has only recently ceased on 1 April 2023, there are no existing private insurance riders that cover non-CDL treatments. However, it is likely that private insurers may offer such riders in the future. Thus, we may have the future option to purchase this additional insurance coverage at our own cost. These riders are likely to command a hefty premium due to the high-cost nature of non-CDL treatments.
Another option for those who want additional protection in the interim is to increase our critical illness coverage to cover the additional cost we expect to incur with non-CDL treatments. While critical illness coverage is not intended to cover ongoing medical treatment, it does provide a lump-sum payout that may be used for this purpose.
Cancer Patients May Claim More For Cancer Drug Services
In line with the MediShield Life changes, the Medisave withdrawal limits were adjusted for cancer drug treatments and services. This allows more Singaporeans to pay less out-of-pocket for cancer drug treatment as MediShield Life co-payments can be paid with MediSave.
Additionally, as announced on 4 March 2023, the MediShield Life claim limit for cancer drug services (such as scans, blood tests, doctor consultations and supportive care drugs) was increased to $3,600 per calendar year from 1 April 2023.
|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 $3,600 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^.|