All parties need to play their part to keep cancer care costs sustainable

We refer to Mr Francis How Chee Kuen’s letter, “Holistic approach needed to tackle cancer care costs” (May 2).

Mr How, a financial adviser, felt that pharmaceutical companies and doctors should play a part in tackling cancer care costs too. That is precisely what the recent policy changes aim to do.

First, the Cancer Drug List (CDL) encourages pharmaceutical companies to lower their drug prices to get these listed on the CDL and be eligible for subsidies and/or MediShield Life and Integrated Shield Plan (IP) coverage. Since the changes, pharmaceutical companies have reduced their prices by an average of 30 per cent, and over 60 per cent for some drugs. We will continue to encourage them to lower the prices for even more drugs to benefit patients.

Second, the CDL nudges patients and doctors towards clinically proven and more cost-effective treatments, and away from high-cost cancer drugs whose costs are not commensurate with their clinical benefits. An example raised by Mr How is darolutamide. While it is listed on the CDL for prostate cancer and covered under MediShield Life and IPs, it is not subsidised as it is less cost-effective than other CDL drugs for prostate cancer that provide similar outcomes at a lower cost.

Third, doctors, especially private clinicians, need to charge reasonably too. The Ministry of Health (MOH) is exploring greater transparency of cancer drug prices so that patients can compare prices and make informed decisions.

However, some doctors may charge high prices also because of insurance practices. Specifically, “as-charged” IPs undermine discipline in charging and healthcare utilisation. MOH has therefore taken a major step to require IPs to set claim limits for cancer drug treatments. We will continue to monitor the situation and, if necessary, work with the Monetary Authority of Singapore to take further steps.  

As explained before, our CDL is more comprehensive than similar listings in most developed countries. For the minority of patients who need non-CDL treatments but are unable to afford them, MOH will facilitate their referrals to subsidised care if needed, and they can be supported through financial assistance on a case-by-case basis.

This is how we manage rising cancer costs holistically. We encourage all parties to play their part.

Lee Shuyi
Director (Finance Partnerships and Commissioning)
Healthcare Finance Group
Ministry of Health