FAQs on Cancer Treatment Financing

Before 1 September 2022, MediShield Life pays up to $3,000/month for all cancer drugs and Integrated Shield Plans (IPs) often cover costs above that on an as-charged basis (i.e., no limit), with a small co-payment. 

Such a design meant that drug companies had no incentive to charge lower prices for drug treatments that cost less. As a result, we ended up paying higher prices for many cancer drugs compared to other countries such as Australia, South Korea and United Kingdom. 

The changes to cancer treatment financing allow us to negotiate lower prices for cancer drugs, and ensure that cancer treatment costs and insurance premiums remain affordable for Singaporeans in the long term. 

MediShield Life and MediSave will only cover treatments on the Cancer Drug List (CDL) from 1 September 2022. Each cancer drug treatment on the Cancer Drug List (CDL) will have its own MediShield Life claim limits and MediSave withdrawal limits. 

You may refer to the Cancer Drug List on MOH for the list of cancer drug treatments that are claimable under MediShield Life and MediSave, and their respective claim and withdrawal limits. Please consult your doctor if you wish to find out whether the treatment that you are undergoing is on the CDL. 

The CDL will only come into effect for Integrated Shield Plans (IPs) on 1 Apr 2023, upon renewal or application. If you have an IP, you will continue to be covered under your current policy terms until it is renewed on or after 1 Apr 2023. 

No, the Cancer Drug List does not apply to inpatient cancer drug treatments as these are covered separately under the inpatient claim limits for MediShield Life and MediSave, together with other costs incurred during the inpatient stay. 

The MediShield Life inpatient daily ward and treatment charges claim limit is $1,000 per day for the first two days and $800 per day for the third and subsequent days of normal ward stay, and the MediSave inpatient daily hospital charges withdrawal limit is $550 for the first two days and $400 for the third and subsequent days of the ward stay.

We encourage you to discuss with your doctor if there are suitable alternatives on the Cancer Drug List (CDL) that are subsidised and covered by insurance. However, if switching treatments is not feasible, there is support to help you if you face difficulty affording your treatment.

• If you are a subsidised patient, you can approach a Medical Social Worker (MSW) in your public healthcare institution (PHI) for financial assistance such as MediFund. 
• If you are a private patient, you can approach your doctor to refer you to subsidised care in a PHI. The PHI’s medical team will review your treatment plan and provide financial counselling (e.g., eligibility for subsidies) before you decide whether to transfer to a PHI.

There will also be support to help existing patients see through their current course of treatment:

• MOH will provide additional financial support for all PHI patients without an Integrated Shield Plan (IP), and who had started treatments that are unsubsidised or not on the CDL before 1 Sep 2022.
• If you have an IP that is being renewed between 1 Apr 2023 and 30 Sep 2023, and have received cancer drug treatment between 1 Jan 2023 and 31 Mar 2023, insurers have committed to preserve your current IP coverage until 30 Sep 2023.  

IP riders may also cover selected treatments beyond the CDL, though the extent of coverage may vary. A summary of each insurer’s IP and rider coverage for cancer drug treatments / services can be found here. You may wish to check with your insurer, should you have further queries on your IP and rider coverage.

Patients who need more than one cancer drug treatment on the Cancer Drug List (CDL) in a month may claim up to the higher of the MediShield Life, MediSave and Integrated Shield Plan claim limits applicable for the individual treatments, if the treatments are used according to their indications on the CDL. 

For example, if a patient uses Treatment X (MediShield Life claim limit of $2,000 & MediSave withdrawal limit of $600) and Y (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.

Please consult your doctors if you wish to clarify the claim limit that will apply for your treatment.

Generally, the Cancer Drug List comprises of drugs that are clinically proven and more cost-effective in treating a particular cancer. A drug is clinically proven if it is registered with the Health Sciences Authority (HSA) for the particular clinical indication and has met the required standards of safety, quality and efficacy. A drug is cost effective if it provides good value in treating the particular cancer as compared to the existing standard of care, in terms of health benefits and cost.

Companies are responsible for demonstrating the clinical- and cost-effectiveness of cancer drug treatments through the company-led submission process to the Agency for Care Effectiveness (ACE), Singapore’s national Health Technology Assessment (HTA) agency. 

Based on the evidence and companies’ price proposals, the MOH Drug Advisory Committee (DAC), chaired by the Director of Medical Services in MOH and comprising senior public sector doctors, pharmacists and MOH representatives, makes recommendations to MOH for subsidy and MediShield Life coverage. 

More details on the processes and methods can be found on ACE’s website.

Since 2022, companies are responsible for providing evidence submissions and price proposals for their cancer drug treatments to be assessed for inclusion on the Cancer Drug List in parallel with their assessment for regulatory approval by HSA. More information can be found here. 

Clinicians can also request ACE to evaluate treatments for potential inclusion on the list using the attached application form.  Clinicians who wish to leverage this route should prioritise treatments that are (i) considered standard of care for a rare cancer or (ii) for a specific subgroup of patients with no suitable registered treatment alternatives, and (iii) approved by at least one reference overseas regulatory authority.

All drug applications should be endorsed by the Chairman of the Medical Board (or equivalent body e.g. Medical Director) of the clinician’s institution before submission to MOH_DAC_Secretariat@moh.gov.sg, If you wish to check if a treatment is under evaluation prior to completing the form, please contact the MOH DAC Secretariat in the abovementioned email address. 

The CDL will be updated every 4 months. Generally, treatments will remain on the positive list unless there are strong reasons to remove them. Treatments may also have their claim limits adjusted (e.g. if a generic or biosimilar becomes available) or removed (e.g. if the company increases the price to non-cost-effective levels). 

Where there is a change in the CDL, the prevailing limits or listing based on the date of treatment will apply. If the patient had received the treatment before the drug was listed / after the drug was delisted, there would be no MediShield Life, MediSave or Integrated Shield Plan payout. MOH will provide sufficient notice to medical institutions and insurers to implement any changes to the CDL, and patients are encouraged to switch to alternative subsidised treatments on the list, where possible.

Yes, patients may claim for cancer drug services from the annual Cancer Drug Services limit even if the service was rendered for a cancer treatment not on the CDL (i.e. the claim limit is not specific to treatments on the CDL). However, cancer drug treatments that are not on the CDL cannot be claimed under the Cancer Drug Services limit.

The cancer drug services benefit is meant to cover services that patients may require ancillary to their main cancer drug treatment.

Hence, if the drug is a supportive medication to manage the symptoms and side effects of treatment (e.g. antibiotics to reduce risk of infection, pain medication or anti-nausea medication), it may be claimable under the Cancer Drug Services limit. 

However, if the drug is used for the treatment of the cancer / tumour itself (e.g. chemotherapy, immunotherapy or targeted therapy), it should be claimed under the Cancer Drug Treatment limit instead. Cancer Drug Treatments that are not listed on the Cancer Drug List are not eligible for MediShield Life, MediSave and Integrated Shield Plan claims and should not be claimed under Cancer Drug Services limit.