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NOTICE PAPER NO. 1849
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON OR AFTER 21 APRIL 2023
Name and Constituency of Member of Parliament
Mr Yip Hon Weng
MP for Yio Chu Kang SMC
Question No. 4428
To ask the Minister for Health (a) in the past year, what is the proportion of cancer patients who have exceeded the annual claim limits of $1,200 from MediShield Life and $600 from MediSave for their cancer treatment; (b) what assistance is available for such patients; and (c) whether the Ministry will consider creating a separate claim category for the coverage of elective cancer drug services to avoid exceeding the claim limits for essential cancer drug services.
NOTICE PAPER NO. 1854
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON OR AFTER 21 APRIL 2023
Name and Constituency of Member of Parliament
Ms Mariam Jaafar
MP for Sembawang GRC
Question No. 4444
To ask the Minister for Health (a) whether insurers offering massive additional coverage for cancer treatment through their riders is a cause for concern for the Ministry; and (b) whether such riders undermine efforts to contain cancer drug costs.
NOTICE PAPER NO. 1856
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON OR AFTER 21 APRIL 2023
Name and Constituency of Member of Parliament
Mr Yip Hon Weng
MP for Yio Chu Kang SMC
Question No. 4459
To ask the Minister for Health (a) how will the implementation of enhanced riders offered by Integrated Shield Plan (IP) insurers to offset limits on oncological treatment coverage affect the Ministry's efforts to curb rising costs of cancer treatments in Singapore; (b) whether MediSave will be permitted to pay for premiums of these riders and, if so, whether this will contradict the Ministry's intent to impose limits on cancer treatment coverage; and (c) whether policyholders who opt for these enhanced riders will be required to have a minimum co-payment of their medical bills subject to a cap each year.
NOTICE PAPER NO. 1854
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON OR AFTER 24 APRIL 2023
Name and Constituency of Member of Parliament
Mr Chua Kheng Wee Louis
MP for Sengkang GRC
Question No. 4455
To ask the Minister for Health (a) whether the Ministry has considered the potential for profiteering by insurance providers from the new Cancer Drug List (CDL) legislation through the incentivising of riders and Critical Illness (CI) plans; and (b) whether the Ministry has conducted any consultation with insurance providers prior to the introduction of the CDL legislation.
NOTICE PAPER NO. 1861
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON OR AFTER 24 APRIL 2023
Name and Constituency of Member of Parliament
Mr Saktiandi Supaat
MP for Bishan-Toa Payoh GRC
Question No. 4475
To ask the Minister for Health for each of the last five years (a) whether the Government has data on the total number of Singaporeans and permanent residents who have received cancer treatment; (b) what proportion of those patients are treated in public and private healthcare institutions respectively; and (c) what is the public cost of cancer treatments to the Government with the introduction of the Cancer Drug List in August 2021 and the introduction of separate claim limits for drugs and services in September 2022.
Answer
1 Mr Speaker, may I have your permission to answer PQs 2 to 4 together please? My response will also cover the matters raised in the questions by Mr Louis Chua and Mr Saktiandi Supaat which are scheduled for a subsequent sitting. I would invite Members to seek clarifications, if need be. If their questions have been addressed, it may not be necessary for them to proceed with the Questions for future sittings.
2 Let me first provide some facts that have been requested. The annual number of Singapore Citizens and Permanent Residents who received cancer drug treatment and services increased from 22,500 in 2017 to 31,500 in 2021 which is a 40% increase. 84% received treatment in Public Healthcare Institutions (PHIs) and 16% in private medical institutions, and this proportion has remained stable over the past few years.
3 A member asked about the adequacy of the MediShield Life claim limit for cancer drug services. We have received similar feedback earlier, and have recently increased the claim limit for cancer drug services from $1,200 to $3,600 per year, which is an increase by three times. This is sufficient to cover the essential cancer drug services incurred by more than 9 in 10 subsidised patients in our PHIs.
4 Other members raised concerns that generous insurance coverage, especially Integrated Shield Plans (IP) and IP plus riders provided by commercial insurance companies, will continue to contribute to the rapid escalation of cancer drug prices. I thank the members for sharing MOH’s concern, which gave rise to the recent policy changes.
5 But first let me explain the key reasons for the rapid rise in cancer drug prices over the past years.
6 Firstly, as a small market, Singapore lacks negotiating power and can pay higher procurement prices. With the Cancer Drug List (CDL) announced in August 2021, drug companies have lowered their prices in order to include their drugs in the CDL so that they can get financial coverage, mainly subsidy plus MediShield Life and IP coverage. Since these changes, we have negotiated an average cost reduction of 30% for most drugs, and over 60% for some drugs.
7 We can plough the money saved on procurement costs into more subsidies. Annual government spending on cancer drug subsidies increased from about $12 million for about 50 drugs before the CDL announcement in August 2021, to around $80 million for more than 100 drugs from September 2022.
8 Secondly, because of the high level of anxiety surrounding cancer, high-cost cancer treatments are often prescribed even where costs are not commensurate with established clinical benefits. Overseas studies have found that about half of new cancer treatments were introduced without evidence of benefit to survival or quality of life. However, patients and their loved ones all hope for a cure.
9 ‘As-charged’ insurance policies, including IPs and riders, are policies where coverage can be effectively limitless and patients have limited co-payment. They further encourage this practice where non-cost-effective cancer treatments are prescribed. These are as-charged insurance policies.
10 The CDL also addresses this issue. It sends a strong signal to patients and doctors to use clinically proven and cost-effective treatments, which are covered by subsidies and MediShield Life from 1 September 2022 and IPs from April 2023.
11 Now, you still have riders which can still cover non-CDL treatments, but with the policy changes effected by the CDL, the costs of these treatments will have to be reflected in the rider premiums, rather than loaded onto MediShield Life and IP premiums for the broad majority. In other words, the high cost of non-cost-effective drugs will not be socialised.
12 Thirdly, the mark-up of cancer drugs by some healthcare providers may be significant. This is again encouraged by “as-charged” IPs and riders, which provide for effectively limitless claims.
13 MOH had in 2018 taken steps to moderate this by requiring all new riders to have a minimum co-payment of 5%, typically capped at $3,000 a year for treatments from panel doctors. From 1 April 2023, we took another step to require IPs to set claim limits for cancer drug treatments, instead of having no limits at all. IPs ceased to be ‘as-charged’. For cancer drug treatments, most IPs provide coverage of up to 5 times of the MediShield Life limit for treatments on the CDL. This is sufficient to cover cost-effective CDL treatments at up to 2.5 times that of unsubsidised PHI prices.
14 A few members have also raised concerns that the new CDL limits for riders – such as 18 times of the MediShield Life claim limits - continue to be high and can push up cancer drug prices.
15 MOH shares the concern. We will review how to improve the transparency of cancer drug prices to help patients make informed decisions and encourage providers to calibrate their mark-ups.
16 We are also monitoring cancer drug claims and coverage closely and will work with the Monetary Authority of Singapore (MAS) to take further steps to regulate IPs and riders if costs continue to escalate.
17 In the meantime, we urge individuals to consider the long-term cost of the insurance products they purchase against the level of protection that they need. The fact is that our CDL is more extensive than similar listings in most developed countries, including South Korea, Australia, and the UK.
18 MAS also requires insurance intermediaries to properly assess if a health insurance product is suitable for a customer’s needs and financial situation before recommending the product to the customer.