Important to keep treatment costs and insurance premiums sustainable

The articles, "MediShield Life and some Integrated Shield Plans cover off-label use of drugs to treat cancer" and "Cancer patient ends up with $33,000 bill after insurer refuses to pay for drug" (April 21), may have given the impression the patient was unreasonably denied the use of Pertuzumab for bile duct cancer.

The letters, "Share clinical insights gleaned from patient management at a systemic level" and "Set up national body to decide quickly on medical treatment in exceptional cases" (April 23), also mentioned treatments not covered by MediShield Life (MSHL) and Integrated Shield Plans (IPs).

The use of Pertuzumab for bile duct cancer has not been approved by any reference regulatory agency in the United States and Europe, or by the Health Sciences Authority. There is limited evidence from a study of 39 patients, which concluded further randomised trials would be needed to assess its efficacy relative to other treatments.

Cancer is a serious disease and we understand how patients may want to pursue all available treatments recommended by their doctor. Unfortunately, cancer drugs are often highly costly, and may lack sufficient evidence of clinical efficacy when used off-label.

From 2017 to this year, the number of MSHL claimants and payouts for outpatient cancer drug treatments increased by 29 per cent and over 50 per cent respectively. If MSHL or IPs continue to cover all such uses, claims and premiums may increase unsustainably and become unaffordable to many.

The Ministry of Health (MOH) hence announced in August last year that from Sept 1 this year, MSHL will cover only a positive list of clinically proven and cost-effective cancer drug treatments. IPs will adopt the same list for policies sold or renewed from April 1 next year.

This will keep premiums and treatment costs more sustainable for Singaporeans in the long run. Subsidised patients can already apply for assistance if they face challenges paying their bills. Riders and private insurance not payable by MediSave may continue covering treatments outside the list.

MOH will be engaging oncologists to emphasise these changes, so they can provide appropriate advice and financial counselling, including whether treatments are on the positive list. Oncologists can request that treatments be assessed for inclusion if there is sufficient clinical evidence.

MOH will also work with IP insurers to update policyholders of these changes in coverage.

Lee Shuyi

Director, Finance Partnerships and Commissioning

Ministry of Health