SINGAPORE —  Changes to the Integrated Shield Plans (IPs) will be implemented this coming Saturday (1 Apr), as part of a larger effort by the Ministry of Health (MOH) to control healthcare costs in Singapore.

Cancer treatment costs, in particular, have been a major concern, with some patients facing bills that run into hundreds of thousands of Singapore dollars.

Under the new rules, patients on IPs will only be covered for cancer treatments on the Cancer Drug List (CDL). This list includes only drugs that have been clinically proven to be effective as well as provide value for money.

According to MOH, about 90 per cent of cancer drug treatments approved for use by the Health Sciences Authority are on the CDL. This means that some patients who are currently receiving non-CDL cancer treatments may need to switch to a different drug, pay for the treatment out of pocket, or explore other options.

The 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 1 April, 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.

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

This is the second phase of the MOH’s efforts to slow the spiralling cost of cancer treatments in Singapore, which has been growing at 20 per cent per 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.

The MOH’s changes to IPs have sparked concern among some oncologists in private practice, who worry that the coverage may not be enough for some patients. However, MOH has stated that it hopes these changes “will keep cancer treatments and insurance premiums affordable in the longer term”.

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 S$200 to S$9,600 a month, while coverage at five times the amount of MediShield Life coverage would come to a maximum of S$1,000 to S$48,000 a month for IPs.

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 S$9,600 a month cap.

For cancer services, MediShield Life pays up to S$1,200 a year now, which will be raised to S$3,600 from April 1, 2023. Patients on IPs will be covered up to a maximum of S$18,000 a year, or about S$1,500 a month. Cancer services include everything other than drugs, such as consultation fees, tests and supportive drugs that treat nausea or infections caused by the treatment.

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 in Singapore with IPs, or slightly more than 70% of Singaporeans and permanent residents, do not have riders.

Responding to a parliamentary question from Mr Louis Chua Kheng Wee, Workers’ MP for Sengkang GRC, Health Minister Ong Ye Kung explained that the changes to IPs would affect only a small percentage of cancer patients, as the vast majority of patients are already receiving CDL treatments. He added that insurers have committed to preserving the current IP coverage of policyholders until at least 30 September 2023, to give patients time to adjust to the new rules.

Minister Ong also noted that 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. MediFund is a government-funded scheme that helps low-income patients pay for their medical bills.

Mr Louis Chua had also asked what measures would be put in place for patients whose IPs’ coverage would cease from September 30, 2023.

In response, Minister Ong stated that while some patients are currently undergoing treatment using drugs not on the CDL, most of them continue to be covered by their IP insurance. Based on the typical duration of cancer treatment, most patients would have completed their treatment with non-CDL drugs by then.

For those whose treatments extend beyond 30 September 2023, there are several possibilities, said the Minister.

Mr Ong said that it is possible that as the CDL continues to expand, it may include their treatment by then.

He added that doctors and patients may also consider shifting towards CDL treatments that are clinically proven and more cost-effective.

If non-CDL treatments continue to be needed, they may still be covered by private insurance products such as IP riders or critical illness plans that patients have previously purchased.

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