Cancer Drug Treatments

NOTICE PAPER NO. 1130 
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON 4 JULY 2022

Name and Constituency of Member of Parliament
Dr Lim Wee Kiak
MP for Sembawang GRC 

Question No. 2883

To ask the Minister for Health regarding exceptional cases where patients urgently require drugs that are not within the HSA’s approved list (a) how can the Ministry assist these patients who require non-standard treatment options to qualify for claims under the current health insurance policy; (b) whether the Ministry will consider setting up a national body where medical experts can be swiftly mobilised to consider and approve these requests; and (c) how often does the list of approved drugs gets updated to keep pace with medical advances.

NOTICE PAPER NO. 1200 
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON 4 JULY 2022

Name and Constituency of Member of Parliament
Mr Gerald Giam Yean Song
MP for Aljunied GRC

Question No. 3031

To ask the Minister for Health whether the Ministry has plans to establish and fund a National Cancer Care Appeals Board consisting of doctors from different specialties to consider appeals from doctors on behalf of individual patients with complex cancers for whom standard therapies may be inappropriate or ineffective, review real world evidence and make timely decisions on whether to allow insurance coverage and Medisave use for off-label drugs or drugs not on the Cancer Drug List.

NOTICE PAPER NO. 1183 
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON OR AFTER 5 JULY 2022

Name and Constituency of Member of Parliament
Mr Yip Hon Weng
MP for Yio Chu Kang SMC

Question No. 2983

To ask the Minister for Health (a) how many cancer patients will be affected by the new policy that limits insurance coverage for outpatient cancer drug treatments; (b) what is the recourse for patients who do not respond to these drugs; and (c) how often will the list of drugs be reviewed to ensure that it stays abreast with medical developments especially new and rare cancers.

NOTICE PAPER NO. 1200 
NOTICE OF QUESTION FOR WRITTEN ANSWER
FOR THE SITTING OF PARLIAMENT ON 4 JULY 2022

Name and Constituency of Member of Parliament
Mr Gerald Giam Yean Song
MP for Aljunied GRC

Question No. 1872

To ask the Minister for Health (a) whether the Ministry has assessed the extent to which the new limitations on insurance coverage and Medisave use for cancer drug treatments will impact doctors’ treatment decisions for their patients based on their clinical judgement; and (b) how will it affect patient care for those suffering from less common cancers.

Oral Answer

Madam Deputy Speaker, with your permission, may I address Questions 8 and 9 for oral answer in the order paper, and also Question 71 and written PQ 41 filed by Mr Gerald Giam¹ for the sitting on 4 July please?

The current claim limit that is applied to all types of cancer drugs give pharmaceutical companies little or no reason to lower prices and takes away the Government’s negotiating power. This has resulted in an unsustainable rise of cancer drug prices. If left unchecked, cancer drugs will eventually be unaffordable for the majority of cancer patients.

The changes, focusing MediShield Life and Integrated Shield Plans (IPs) to cover a Cancer Drug List (CDL) of clinically proven and more cost-effective cancer drug treatments, improve affordability in two ways.  First, it provides the incentive for pharmaceutical companies to price their drugs more reasonably so as to benefit from financing coverage. Since we announced the changes in 2021, we have managed to secure an average price reduction of 30%. For some cancer drugs, the price reduction achieved was over 60%. The lower prices have made more cancer drugs cost-effective, enabling 66 more cancer drugs to be listed for subsidy.

Second, nudging utilisation of cancer drugs towards proven and cost-effective care will ensure that treatment costs for the broad majority do not rise unsustainably as a result of liberal use of very expensive and novel cancer drugs. These changes will benefit thousands of patients and improve affordability of more cancer drugs for all Singaporeans.

The CDL is extensive. We already have a panel of experts comprising senior public and private oncologists and haematologists across various specialisations who recommend new treatments for inclusion into the CDL. This panel has approved treatments that cover multiple lines of therapy (beyond first line therapy treatment), as well as rare cancer treatments to the CDL.   

This has allowed us to include around 50 more treatments onto the CDL, since it was announced in August 2021. The current CDL covers some 90% of treatments used in the public sector and is updated every four months to keep up with medical advancements and latest clinical evidence.

However, we note that there could be exceptions where patients do not respond to treatments on the CDL and their doctors may exercise their clinical discretion to prescribe non-CDL treatments based on evidence of benefit. In these cases, doctors must be prepared to justify their clinical decisions to patients and their colleagues. Doctors must also counsel the patient on its risks, efficacy, and costs so that the patient may make an informed choice. Some patients may still be covered for such non-CDL treatments by their private insurance such as riders or critical illness plans.

In this transitional period, the Ministry of Health (MOH) will put in place measures for the small number of exceptional cancer patients who require non-CDL treatments and are affected by the policy changes. Private patients who have difficulty affording their bills may opt to be transferred to subsidised care at public healthcare institutions. Once patients are in subsidised care, they can benefit from more affordable drugs and medical fees, as well as access a range of financial assistance such as MediFund.  All patients can also appeal to use more MediSave.

[1] Question 71: To ask the Minister for Health whether the Ministry has plans to establish and fund a National Cancer Care Appeals Board consisting of doctors from different specialties to consider appeals from doctors on behalf of individual patients with complex cancers for whom standard therapies may be inappropriate or ineffective, review real world evidence and make timely decisions on whether to allow insurance coverage and Medisave use for off-label drugs or drugs not on the Cancer Drug List.

Written Question 41 To ask the Minister for Health (a) whether the Ministry has assessed the extent to which the new limitations on insurance coverage and Medisave use for cancer drug treatments will impact doctors’ treatment decisions for their patients based on their clinical judgement; and (b) how will it affect patient care for those suffering from less common cancers.