What You Need to Know About Changes to Coverage of Cancer Treatments by MediShield Life and Integrated Shield Plans

Starting from 1 September 2022, changes to the framework for subsidising cancer treatments will take effect. This affects all Singaporeans and Permanent Residents on MediShield Life, the national health insurance scheme that provides a basic level of financial protection against hospitalisation and healthcare expenses.

Furthermore, from April 2023, these changes will also apply to holders of integrated shield plans, which are private health supplements that provide enhanced benefits on top of MediShield Life.

Here is a summary of the key changes, how it affects you, and what steps you could take in order to ensure you will have the widest treatment options available to you without being hindered by cost.

How and Why Are There Changes to MediSave Life Claims Framework

The MediShield Life scheme is regularly reviewed to ensure it remains fiscally sustainable, keeps pace with advances in medical science, and continues to fulfil its purpose of providing Singaporeans and Permanent Residents with affordable coverage for their healthcare expenses.

The MediShield Life Council undertook its first major review in 2020. In light of rising costs of new medical procedures, changing population demographics, the council noted that claims have increased significantly year-on-year, with a disproportionate amount coming from cancer treatments.

With the goal of ensuring the entire MediShield Life scheme works for all policyholders today and into the future, changes to the claims framework and quantum were proposed by the MediShield Life Council and accepted by the government in 2021. The changes were then announced and slated to take place in 2022 and beyond.

Summary of Changes to MediShield Life and MediSave Framework for Cancer Treatments

Instead of a blanket claim limit of $3,000 a month for all cancer drug treatments and associated services, there will now be a range of claimable limits of between $200 to $9,600 a month, so long as the prescribed treatment is on the Ministry of Health’s Cancer Drug List

The government notes that this list covers 90% of treatments used in public hospitals, and should not negatively impact the majority of patients. Furthermore, an additional $1,200 a year can be claimed for cancer drug services.

Alongside changes to MediShield Life claim limits for cancer treatments, revisions were also made to MediSave withdrawal limits. Previously, a maximum of $1,200 a month can be withdrawn for all cancer drug treatments and services, and an additional $600 a year can be used for cancer scans.

The new changes mean that the monthly withdrawal limit drug treatments is now $1,200 (for approved treatments with MediShield Life claim limit above $5,400) or $600 (for approved treatments with MediShield Life claim limit of or below $5,400). The additional $600 annual withdrawal limit can be used for cancer scans and/or cancer drug services.

Included in this round of changes were enhancements to the Medication Assistance Fund (MAF), which provides tiered subsidies for prescription medications based on household income. The MAF was previously only given to patients with monthly per capital household income of $2,800 or less. Subsidies will now be extended to patients with per capital monthly household incomes of up to $6,500. These changes will take effect from 1 November 2022.

Understanding the MOH Cancer Drug List and Ban on ‘Off-Label’ Cancer Treatments

Examining the Cancer Drug List, you will notice that in addition to listing the name of the drug, the specific cancer that it is approved for use against is also listed. This means that for the treatment to be claimable, both the approved drug and approved usage of the drug must be met.

In the treatment of cancer, it is not uncommon for doctors to take a particular cancer drug that is commonly used to treat one form of cancer, and use it to treat patients with other forms of cancer, especially when these patients have not responded well to conventional treatments. This practice is known as off-label treatments.

This revision to rules surrounding usage of MediShield Life and MediSave for cancer treatments mean that off-label treatments will not be claimable. This is aimed at curbing the use of expensive and potentially unproven cancer treatments.

MOH has formed an Oncology Drug Sub-committee (ODS) and Drug Advisory Committee (DAC) that comprises clinical experts from both private and public healthcare institutions to regularly review the list.

There will also be a mechanism for doctors and pharmaceutical companies to request the evaluation of drugs and treatments for inclusion into the approved list if there are grounds to do so, such as clinical studies showing efficacy and cost-effectiveness.

What These Changes Mean for You and What You Can Do to Enhance Your Coverage

Ever since the changes were announced, there were anecdotal cases covered in the media about how cancer financing loopholes led to patients racking up astronomical bills on treatments that potentially saved their lives. This had led to concerns on whether patients will be left without protection or options if they do not respond to common, approved treatments on the Cancer Drug List.

The government has given assurances that no patient will be left out, and measures will be in place to ensure every genuine case will receive support. While reassuring, the extent of the support remains to be seen and will certainly be observed keenly as these changes take effect.

On a personal level, we can give ourselves greater peace of mind over our healthcare costs and treatment options by exploring critical illness insurance policies and cancer-specific plans. Both of these provide lump sum payouts upon diagnosis of cancer, which can be used at our discretion to pursue whatever treatments our healthcare provider and ourselves deem as appropriate.

Such plans traditionally played an income-replacement role, as well as providing us with the option to seek out complementary and/or non-traditional treatments that complement care by within the private or public healthcare system.

If you are interested to find out more about critical illness insurance plans or cancer-specific insurance policies, drop us a message and a MAS-licensed, independent financial adviser will be in touch.

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