[2023] Cancer Drug List (CDL) and changes to cancer insurance, claims, and subsidies

Cancer is one of the leading causes of death in Singapore, accounting for 26.4​% of total deaths in Singapore in 2021. As we face a greying population with people living longer, and with the advance of medical healthcare, we can expect to see more Singaporeans being afflicted with cancer and surviving it. In fact, statistics from the Singapore Cancer Registry show an increase in the number of people being diagnosed with cancer, and a lower percentage of people dying from cancer now as compared to the 1970s. These trends mean that we can expect to be affected by cancer, whether it is us or our loved ones, at some point of time in our lives. Seeing as how cancer and cancer treatment are becoming increasingly common, it would be privy to pay attention to the announcements on changes in cancer drug claims and subsidies implemented recently in September 2022.

Key points on cancer treatment subsidies

1. More will benefit from the Medication Assistance Fund

The Medication Assistance Fund (MAF) subsidises high-cost drugs that are clinically proven and cost-effective. MOH has raised the ceiling for Singaporeans who can benefit from Medication Assistance Fund (MAF) from a per capita household income of $2,800 to $6,500, with subsidies ranging from 40 to 75 per cent. Here are the subsidies that you may be eligible for based on your residency status and your household’s per capita income:

Calculate your PCHI here.

2. Approved and cost-effective treatment methods are listed under the new Cancer Drug List (CDL) 

The Cancer Drug List is a newly-implemented list of cancer drugs for different cancers approved by the Ministry of Health (MOH). These treatments are clinically proven and cost-effective, and are largely safe for use. The list is updated periodically (every four months since its inception, as stated by MOH) to continue expanding the choices for effective and accessible cancer drug treatments.

The CDL aims to mitigate the government’s spending on cancer drug treatments, which has been growing at a rate of 20% per year. With an approved drug list, pharmaceutical companies will have to regulate their drug prices to get a spot on the list and have their drug commercially accessible to most users in the population. 

3.  Changes have been made to MediSave and MediShield Life payouts 

With the CDL, the government has complemented this effort with greater financial subsidies in the form of increased MediShield Life payouts. Before, MediShield Life payouts were capped at a flat rate of $3,000 per month and covered all cancer drugs and treatments.

Now, MediShield Life payouts have been split into 2 separate categories: one for drugs, and one for cancer-related services. Payouts for cancer drugs range from $200 to $9,600 monthly, but only if the specific treatment opted for is on the CDL. Additionally, both of these initiatives would help the average Singaporean offset a greater proportion of their spending on medication per month.

Also, in September 2022, MOH announced that MediShield Life and MediSave will only cover cancer treatments on the CDL for outpatient treatment. This means that if you opt for a treatment or medicine that is not on the CDL, you will not be able to offset your treatment costs with your MediShield Life coverage or your MediSave.

4. There is now a limit on insurance coverage for cancer treatments 

The CDL is not only applicable to government-linked financial aid but will also affect those of us who are covered under an Integrated Shield Plan (IP), which comprises of MediShield Life and a private insurer component.

Previously, IPs provided “as-charged” coverage, which means that there was no limit on the claimable amount, subject to a small amount of co-payment.

However, from 1st April 2023, your IP will only cover drugs under the CDL. If you purchase or renew your IP in April 2023, these changes will apply to your policy.

Your IP coverage 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 $9,600 a month.

What are the implications of the changes? 

1. More affordable cancer treatments 

The aim of having the CDL and the increased claim amount for MediShield Life is to create greater affordability in cancer treatment for the masses. As medical treatment advances, more treatments are available at a higher cost. The national spending on cancer drugs is growing at 20% per year, compared to 6% per year for non-cancer drugs. This shows that cancer treatment is one of the bigger treatments in demand by Singaporeans. Moreover, the number of people using MediShield Life to claim cancer drug treatments has increased by about 30% from 2017 to 2020, and payouts for cancer drug treatments have increased by more than 50% from 2017 to 2020.

Previously, when MediShield Life claims were capped at $3,000 a month, those who were utilizing this would only be able to claim up to $3,000 of cancer drugs. This would mean that they would have fewer types of cancer drugs to choose from in treatment and creates a differentiation between the wealthy and the average person in cancer treatment. Raising the claim amount for MediShield Life would help to tackle this disparity of unintentionally limiting cancer treatment options, and in turn, treatment outcomes, to be affected by what one can pay for. 

2. Impact on treatment options

If a particular medication is not on the CDL, patients can no longer tap on their MediShield Life or MediSave to buffer the cost of their medication starting from 1 April 2023. This would mean fewer choices available for those who want to use the above-mentioned methods to fund their treatment.

However, as of 30 March 2023, many private insurers have increased their riders’ cancer coverage, while some IP providers have new policy boosters if you want coverage for certain drugs that are not on the Cancer Drug List (CDL).

For treatments not included in the CDL, oncologists can request for evaluation for a treatment to be included on the list if there is sufficient clinical evidence to support their use. The CDL will be updated every four months, which means that the choices you may have for subsidised cancer care may expand in the future. 

3. Changing coverage for individuals currently seeking treatment for cancer 

What about cancer patients who are presently receiving treatment for cancer? For those whose drugs are under the CDL, they can look forward to greater subsidies from MediShield Life and Medisave. The more pressing concern would be for patients whose treatments are not covered under the CDL. From 1 April 2023, IPs will be privy to the CDL in cancer drug treatment as well. This means that patients under non-CDL drug treatments will have to fund their treatment expenses otherwise. 

Currently, those who are undergoing cancer treatment will have their current coverage extended for six months, to allow them to complete their current treatment.

Beyond 30 September 2023, MOH has suggested a few possibilities for cancer patients:

• As the CDL list is continually updated every four months, users may find that previously unapproved drugs are now approved on the list. Then, they would be able to use government subsidies and IP to pay for their treatment. 
• Patients and doctors could consider using drug treatments on the CDL as they are clinically proven and 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. This is depending on the private insurer. 

4. Non-CDL drugs will have to be self-funded or covered by insurance riders

If IPs and government-related funds are not permitted for use for non-CDL drugs, this would mean that users of non-CDL drugs will have to foot the bill from their own pocket – especially if the individual has no other insurance policies.

As of April 2023, some insurers are offering new riders that do provide coverage for non-CDL treatments. These may be helpful if you or a loved one are currently on a non-CDL drug.

Funding non-CDL cancer treatments 

Since the benefits of CDL accrue mostly to users whose drugs are under the CDL, what about those who use drugs not under the CDL? There are various options to fund treatment, but before going ahead to purchase funding options, consider the following factors:

• Relevance and probability of cancer diagnosis: If you come from a family with a strong history of cancer, you are more predisposed to the risk of getting cancer as well. Moreover, the type of cancer running in your family history is in question as well – is it a rare type of cancer where treatment may be more complicated and require less common treatment methods? 

• Stage of life and financial situation: Depending on your age and the stage of life you are in, your cancer risk and available financing options may vary. If you have just graduated and come out to work, chances are you would be building up income and wealth, and less insurance options would be open to you.
• Your current state of health: If you have preexisting conditions (for example, diabetes), this may make getting insurance coverage more complicated. 

With that being said, here are some options for funding non-CDL treatments. 

Government-related

MediFund

MediFund is an endowment fund set up by the Government. It provides a safety net for patients who face financial difficulties with their remaining bills after receiving Government subsidies and drawing on other means of payment including MediShield Life, MediSave and cash. The government takes the interest income earned from MediFund and distributes them to approved healthcare institutions so that they can use this sum to assist with medical bill payments of needy patients. If need be, MediFund can be applied for patients who are using non-CDL drugs but are unable to afford the sum of payment entirely, subject to approval from relevant authorities.

Private insurer-related

Integrated Shield Plan (IP) rider 

IP riders are optional supplementary plans or add-ons designed to provide additional coverage on top of the IPs.While IPs cannot be used to fund non-CDL treatments beyond 1 April 2023, insurers may elect to offer choices to users to pay for such treatments through these IP riders. Why is this so?

IPs are funded by MediSave, while riders are paid from your own pocket. This means riders are not privy to the new ruling on payments for CDL and non-CDL drug treatments, and can be used as a means to pay for non-CDL treatments. 

To help establish a common understanding of non-CDL treatments across all stakeholders (e.g. insurers, users, healthcare providers), The Life Insurance Association of Singapore (LIA) has developed a Non-CDL Classification Framework. This is a standardized classification for the different cancer drug treatments not on the CDL, and groups cancer drug treatments according to regulatory approvals and clinical guidelines. IP insurers are to refer to this Classification Framework to decide which non-CDL treatments can be covered within their IP riders. 

Critical Illness Plans

Critical illness plans are insurance plan that cover 37 critical illnesses registered under the LIA. The insurance can be used to cover the cost of treatments or other additional expenses such as needing to hire additional help. Typically individuals will be considering between two types of critical illness plans: early critical illness plans or regular critical illness plan.s 

Early critical illness insurance covers all the early stages of the 37 different types of critical illnesses. Critical illness insurance, likewise, covers all 37 types of critical illness but only at the intermediate or later stages of the illnesses. Early critical illness insurance plans are usually more expensive than critical illness plans due to the extensive coverage they provide starting from early stage illnesses. 

Cancer Insurance 

A standalone cancer insurance plan covers against cancer only and usually provides a lump sum payout with a cancer diagnosis regardless of the stage of cancer. If someone has a strong family history of cancer, and considers the cost of critical illness insurance too high, they can consider cancer insurance instead. The lump sum payout can be used to offset non-CDL drug treatments. 

Conclusion

The announcement of the changes to cancer drug claims and subsidies with the CDL is overall a welcomed move by many – after all, the aim of introducing the CDL is to make cancer drug treatments more affordable and accessible to many. With concerns of the lack of funding for non-CDL drugs, it is important to note that most cancer patients would be utilizing drugs on the CDL. Currently, only about one in 10 private cancer patients is treated on non-CDL drugs. However, the announcement is fairly recent so look forward to seeing more changes in insurance coverage for non-CDL drug treatments ahead. 

Besides funding cancer treatments, caregiving and help should be considered in helping the cancer patient with living their daily life. Homage has a variety of options of caregiving and medical services – all in the comforts of home. 

If you would like someone to help with your loved one’s care, our Care Pros, including caregivers and trained nurses, can help. Reach us at 6100 0055 or fill in the form below for a free Care Consult.