New Co-funding Scheme and Extension of MediSave Coverage to Support Eligible Couples in their Parenthood Journey

1.     The Ministry of Health (MOH) will introduce a new co-funding scheme and extend MediSave coverage for Pre-implantation Genetic Testing for Monogenic/Single Gene Defects (PGT-M) and Chromosomal Structural Rearrangements (PGT-SR) from 1 July 2022. These changes aim to provide financial support for eligible couples who would like to conceive but are at risk of transmitting serious inheritable diseases to their offspring, and are part of the Government’s larger efforts to support couples in their parenthood plans.

2.     In May 2021, MOH introduced PGT-M and PGT-SR as regulated clinical services. PGT-M and PGT-SR are done in combination with Assisted Reproduction Technology (ART). PGT-M is used for screening single gene mutations in embryos that may result in severe forms of genetic disorders, such as spinal muscular atrophy Type 1 and 2, and PGT-SR is for detecting structural abnormalities in chromosomes [1] which may manifest as conditions resulting in developmental delays or learning disabilities.

PGT-M and PGT-SR Co-funding Scheme

3.     From 1 July 2022, couples with at least one Singaporean spouse who are clinically eligible for PGT-M or PGT-SR can receive up to 75% in co-funding by the government, subject to co-funding caps. Similar to the ART and Intra-Uterine Insemination (IUI) co-funding schemes, the level of co-funding and co-funding caps will depend on the citizenship status of the couples.

4.     A typical PGT-M or PGT-SR process involves (i) the pre-test work-up[2], i.e. customisation of the test, and actual testing stages by the laboratory, and (ii) embryo biopsy stage by an assisted reproduction (AR) centre. On average, it takes about six months to one year to complete an in-vitro fertilisation (IVF) cycle and PGT, which includes the work-up, embryo biopsy and testing.

5.     Co-funding will be provided for individual stages of the PGT cycles. The PGT stages eligible for co-funding, and associated co-funding amounts are detailed in Table 1. For each treatment cycle, a couple who are both Singapore Citizens can receive co-funding of up to $12,250 for the entire PGT-SR process, up to $17,100 for the entire PGT-M process for common disorders, or up to $31,420 for the entire PGT-M process for rare disorders. Each couple will be eligible for up to six co-funded cycles of PGT-M or PGT-SR.

Table 1: PGT-M and PGT-SR Co-funding Amount per Treatment Cycle

* The PGT-M work-up for rare disorders is expected to cost more than that for common disorders because it involves more preparatory work.

6.     Co-funding for embryo biopsy is only available for couples whose biopsies are performed at public AR centres. The National University Hospital’s (NUH) Pre-implantation Genetic Diagnosis Centre (PGDC, NUH) is currently the only laboratory in Singapore approved to provide PGT-M and PGT-SR testing, and co-funding for laboratory work-up and testing is available for specimens sent to PGDC, NUH. This includes eligible patients undergoing PGT-M or PGT-SR at private AR centres approved to provide these services, if the private AR centre sends their biopsied specimens to PGDC, NUH.

Eligibility Criteria

7.     Couples who meet all of the following criteria can qualify for co-funding:

i)     At least one spouse is a Singapore Citizen at the start of the PGT-M or PGT-SR cycle;
ii)     The couple must have been assessed by their attending AR practitioner to have met the clinical requirements for PGT-M or PGT-SR; and

iii)     The female spouse must be below 40 years old at the start of the PGT-M or PGT-SR cycle[3], up to the claim limit of six PGT-M or PGT-SR cycles. If the female spouse is 40 years or older at the start of the PGT-M or PGT-SR cycle, the couple will be eligible to receive co-funding for up to two of the six PGT-M or PGT-SR cycles if she has attempted an ART or IUI cycle before 40 years old.

8.     A PGT-M or PGT-SR cycle not completed due to medical reasons is eligible for co-funding and will count as one co-funded cycle. However, if it is not completed due to non-medical reasons (e.g. the cycle is terminated on the couple’s own accord), it will not be eligible for co-funding.

Extension of MediSave Coverage to Cover PGT-M and PGT-SR

9.     Couples who are clinically eligible for PGT-M or PGT-SR will also be able to tap on their own or their spouse’s MediSave, regardless of whether they are seeking care at a public or private AR centre. The combined cost of the PGT-M or PGT-SR, and the associated ART cycle will be subject to the prevailing MediSave limits for Assisted Conception Procedures (ACPs)[4], namely $6,000 for the first cycle, $5,000 for the second cycle, and $4,000 for the third and subsequent cycle, up to a lifetime limit of $15,000 per patient. There will be no age or citizenship restrictions for the use of MediSave for PGT-M or PGT-SR. If the ART cycle with PGT-M or PGT-SR is not completed due to non-medical reasons, MediSave use will not be permitted.

10.     The list of MOH-approved public and private AR centres that eligible couples can approach for PGT-M and PGT-SR services is available on the MOH website.

MINISTRY OF HEALTH

30 JUNE 2022

[1] Chromosomes are structures in the cell that contain the genetic material, deoxyribonucleic acid (DNA). It is essential for reproductive cells, such as oocytes and sperms, to contain the right number of chromosomes and with the correct structure. If not, the resulting embryo or offspring may fail to develop properly.

[2] PGT-M work-up is a pre-PGT phase where a couple’s genetic materials (obtained via blood samples) are used to develop a specific laboratory test which is then optimised and validated for use during the actual PGT. There is no work-up for PGT-SR.

[3] The age criterion for the PGT-M and PGT-SR co-funding scheme is aligned to that for the Assisted Reproduction Technology (ART) co-funding scheme at maternal age 40, after which the success rates of ART drop significantly and continue to fall thereafter.

[4] Assisted Conception Procedures include Intra-Uterine Insemination, and Assisted Reproduction Technology such as in-vitro fertilisation.