Thursday, 19 August 2021

MediShield Life coverage enhanced for cancer treatment from September 2022; to cover drug bills of nearly 90% of subsidised patients

Move to rein in cost of cancer care to help more patients
Insurance, MediSave to fully cover outpatient treatment for 90% of subsidised cancer patients
By Salma Khalik, Senior Health Correspondent, The Straits Times, 18 Aug 2021

More subsidised cancer patients here will get help paying for their outpatient treatments from next year, with changes to the national health insurance scheme.

More cancer drugs will be subsidised and the income criteria will be raised so that more people can get subsidies for certain high-cost drugs under the Medication Assistance Fund (MAF).

With these changes to MediShield Life coverage, 90 per cent of subsidised cancer patients will have their outpatient treatments fully paid for by insurance and MediSave from September next year - up from 70 per cent today.

The move will also have the effect of reining in soaring cancer drug prices.

The MediShield Life Council had set up a committee to look into the high cost of cancer care, and had recommended that the Ministry of Health (MOH) create a list of cost-effective outpatient cancer drug treatments to be covered by MediShield Life.

About 90 per cent of existing treatments in the public sector have been included in the list.

Based on this list of clinically proven treatments, the revised claim limits can range from $200 to $9,600 a month - depending on the drug used - when the changes kick in.

Currently, patients can claim only up to $3,000 a month for all cancer outpatient treatments. "This has the unintended effect of raising cancer drug prices to maximise the claims," said MOH.

The ministry explained that since MediShield Life has been reimbursing $3,000 a month for outpatient cancer treatments, some drug companies have kept their prices high, knowing that the cost would be covered by insurance.

As a result, Singapore has been paying up to double the price paid by Australia, New Zealand, South Korea and Taiwan for some drugs.

Having differentiated cost limits has enabled Singapore to negotiate better rates. On average, cancer drug prices have gone down by about 30 per cent. One drug for kidney cancer dropped in price, from $22,570 a month to $11,340 a month.

The move will address the issue of rising costs, since spending on cancer drugs here has been rising at an annual average rate of 20 per cent, compared with 6 per cent for other drugs, said MOH.

MOH also said 55 more drugs will be eligible for subsidies, bringing the total to 150 drugs.

The subsidised list is published on the MOH website and updated every four months. Oncologists may ask for drugs not on the list to be evaluated.

Meanwhile, about 3,000 more people will become eligible for subsidies under MAF, with the criteria being raised from a per capita household income of $2,800 a month to $6,500 a month.

While most existing cancer drug treatments will continue to be covered, some patients may find they can no longer claim for their current medication. The changes will kick in only in September next year to allow such patients to complete their current course of treatment and adjust their plans.

Dr Tan Yew O, an oncologist in private practice who chaired the Cancer Drug Committee, said some drugs not on the list are novel therapies. "In some instances, there is currently insufficient clinical evidence that these drugs are effective in improving overall survival or duration of response," he added.

Meanwhile, from April 2023, patients undergoing private healthcare treatment covered by Integrated Shield Plans (IPs) will not be able to claim for drugs not on this list.

However, the new rules do not apply to riders, which about a third of IP policyholders have. Riders pay for part or all of a patient's share of the bill.

This is because IP premiums are paid with MediSave, while premiums for riders are paid for in cash.

Mrs Fang Ai Lian, chairman of the MediShield Life Council, said: "Focusing MediShield Life coverage on clinically proven and cost-effective cancer drug treatments will enable Singapore to negotiate for better drug prices and improve affordability for more patients."

She added that this will help to keep MediShield Life premiums affordable for all Singaporeans.

No revision of premiums is expected before the next review in 2024.

Integrated Shield Plans will cover only MOH-approved outpatient cancer treatment from 2023
Coverage to be limited to 150 clinically proven, cost-effective drugs on MOH list
By Salma Khalik, Senior Health Correspondent, The Straits Times, 18 Aug 2021

People who have bought Integrated Shield Plans (IPs) from private insurers may not be able to claim for certain drugs used in outpatient cancer treatments from April 2023.

The Ministry of Health (MOH) has come up with a list of clinically proven and cost-effective cancer drug treatments that can be covered by MediShield Life insurance from September next year.

The same list will apply to coverage by all IPs sold or renewed from April 2023, MOH announced yesterday.

Currently, many IPs cover outpatient cancer treatments on an as-charged basis. This means that treatment costs are capped only by the overall annual limit of the insurance plan, which could exceed $2 million.

With the change, coverage will be limited to the roughly 150 drugs that are on MOH's approved list. Claims cannot be made for drugs that are not on the list.

This coverage for outpatient cancer treatments will also be capped, though the cap can vary depending on the drug used.

The Life Insurance Association of Singapore said: "IP insurers will study the changes and bring their plans into alignment with the direction from MOH."

This new requirement, however, does not apply to coverage by riders, which IP policyholders pay out of pocket to cover the bulk of their share of medical bills. Premiums for IPs are paid with MediSave.

This means that the eight insurers can continue to fully cover the cost of treatment for the more than 1.7 million policyholders who have bought riders.

The Government requires patients with IPs to pay a deductible of up to $3,500 a year before insurance kicks in, and a co-payment of 10 per cent of the rest of the bill.

Prior to 2018, riders could pay for the patient's entire portion of the bill. However, those who bought riders from March 8, 2018, have to pay 5 per cent of the bill, up to a minimum cap of $3,000 a year.

MOH made the change to riders to curb rising healthcare costs, as it found that people who do not pay a cent for their treatment have bills that were 60 per cent higher than patients who did not have riders.

As it stands, unless insurers change the conditions of rider coverage, should a patient with a rider get non-approved outpatient cancer treatment, the rider will pay for all but 5 per cent of the bill.

Associate Professor Jeremy Lim from the National University of Singapore's Saw Swee Hock School of Public Health pointed out that there are two parts to the term "cost-effective". Drugs not on the list might be effective, but may not meet MOH's cost requirement.

He said: "I do hope there is a system for appeal and consideration of exceptions for individual patients, as there won't be a 'one size fits all' for everyone."

MediShield Life changes aim to tackle rising amount Singapore spends on cancer drugs
By Linette Lai, Political Correspondent, The Straits Times, 18 Aug 2021

A year from now, Singapore will adjust MediShield Life - the compulsory national health insurance scheme - to modify claim limits for outpatient cancer drug treatments.

Instead of being allowed to claim up to $3,000 a month for all such treatments and related services, claim limits for these drugs will range between $200 and $9,600 a month.

An additional limit of $1,200 per month will be put in place to cover other cancer-related costs, such as scans, blood tests and doctors' consultations.

The Ministry of Health (MOH) will draw up a fixed list of clinically proven, cost-effective drugs that qualify for the insurance claims.

The aim, MOH said, is to moderate increases in healthcare costs - which are driven partly by expensive cancer drugs - and enable Singaporeans to spend less on out-of-pocket cancer treatments.

But why is Singapore spending so much on cancer treatment in the first place?

The number of people making MediShield Life claims for outpatient cancer drugs rose by 30 per cent between 2017 and last year, from 22,500 to 29,100.

MediShield Life also paid out $168 million in claims for these drugs last year - a 50 per cent rise from what was spent in 2017.

This is also more than double the increase in overall MediShield Life payouts over the same period.

Figures from the Singapore Cancer Registry show that 71,748 people were diagnosed with cancer between 2013 and 2017, compared with 57,303 people in the preceding five-year period.

Cancer is also the leading cause of death here, with three in 10 people expected to die of the disease.

Traditional cancer drugs typically cost several hundred dollars a month, but newer treatments such as immunotherapy - which activates the body's immune system to fight the disease - can cost more than $5,000.

In 2019, Singapore spent $375 million on cancer drugs, which accounted for a quarter of the nation's total drug spending. Medical advancements mean that these costs are likely to continue to rise.

The country's spending on cancer drugs has grown at a compound annual growth rate of 20 per cent between 2017 and last year. This is over three times the 6 per cent growth rate for non-cancer drugs.

If the current trajectory continues, Singapore is projected to spend $2.7 billion on cancer drugs in 2030. This is more than seven times what was spent in 2019.

Singapore pays more for cancer drugs than some other countries such as South Korea and Australia.

MOH has attributed this to the $3,000 claim limit that is applied to all cancer drugs, which gives pharmaceutical companies little or no reason to lower their prices.

This is because companies are typically reluctant to offer better prices if they know that the national insurance programme will cover treatment for Singaporeans.

With the revised claim limits, Singapore will be able to better negotiate with companies and secure lower prices by determining what it deems cost-effective.

The Agency for Care Effectiveness (ACE), which helps identify treatments with "good outcomes at affordable costs", has already started discussions with several firms. It has achieved a 30 per cent reduction on average.

Dr Tan Yew Oo, who chairs the cancer drug committee appointed by the MediShield Life Council, said: "The current MediShield Life claim limit... is quite blunt and does not incentivise drug manufacturers to offer better prices or encourage the use of clinically proven and cost-effective treatments."

The changes to MediShield Life claim limits will mean that Singapore's approach is more similar to what is being done in countries such as Britain and Australia.

There, national funding is provided only for drugs that meet certain standards and have undergone negotiations with pharmaceutical companies to bring prices down to cost-effective levels.

Here, ACE will evaluate drugs and carry out such negotiations. Its proposals will be reviewed by MOH's Drug Advisory Committee.

This committee will make recommendations to MOH, which will publish the list of approved drugs on its website. The list will be updated every four months.

Treatments that are not on this list will not be covered by MediShield Life, although doctors can request their inclusion if there is sufficient clinical evidence to support their use.

33 costlier cancer drugs to be added to subsidised list in a year
By Linette Lai, Political Correspondent, The Straits Times, 20 Aug 2021

In a year, Singapore will add 33 high-cost cancer drugs to the Medication Assistance Fund (MAF), which subsidises expensive drugs that have been deemed clinically necessary.

This means people who have trouble paying for such drugs could get them at up to 75 per cent off, depending on their per capita household income.

There are currently only six cancer drugs on this list.

"Most patented cancer drugs are not subsidised today as they are not cost-effective at current prices," said the Ministry of Health (MOH) in response to queries from The Straits Times.

It added that another 22 cancer drugs will be added to the Standard Drug List (SDL), which subsidises cheaper medications. This makes for a total of 70 cancer drugs on the SDL and 39 on the MAF by September next year.

The ministry's decision to add these drugs to the list comes as part of its latest review of cancer treatment in Singapore.

This review will see changes to claim limits under MediShield Life, with more cancer treatments subsidised even as MOH works to negotiate lower prices for cancer drugs.

Pharmaceutical companies typically charge Singapore more for cancer drugs as compared with other developed countries such as South Korea and Australia.

For instance, Singapore pays more for tyrosine kinase inhibitors for treating lung, liver and thyroid cancer, as well as anti-androgens for treating prostate cancer.

These can cost 1.5 to two times what other countries pay, the ministry said.

The ministry has attributed this cost difference to the $3,000 claim limit that is applied to all types of cancer drugs. Knowing that treatment will be covered by the national health insurance programme up to this limit gives pharmaceutical companies little or no reason to lower their prices.

With the changes, 90 per cent of subsidised cancer patients will be able to have their outpatient treatments fully paid by insurance and MediSave - up from 70 per cent today.

MOH said its negotiations with drug manufacturers are ongoing and have covered about two-thirds of cancer drug treatments so far.

"Following continued value-based pricing negotiations, we have narrowed the price gap with overseas reference countries, and in some instances secured even more competitive drug prices."


No comments:

Post a Comment