Starting from April 1st, 2023, the Cancer Drug List will be implemented for Integrated Shield Plans (IP) in Singapore. This will affect private insurers’ coverage of cancer treatment costs and may impact individuals’ out-of-pocket expenses and care options if diagnosed with cancer in the future.
What are the changes made to the Integrated Shield Plans
All Integrated Shield Plans (IPs) offered by private insurers will only provide coverage for treatments that are included on the approved cancer drug list. This change was already implemented in September of last year for MediShield Life and MediSave, the national medical savings scheme. At present, the majority of IPs provide coverage for outpatient cancer drug treatments on an “as charged” basis, with patients bearing the deductible and co-payments. However, starting from April 1, IP coverage for cancer treatment will be limited to a maximum of five times the MediShield Life claim limit, resulting in lower coverage for most policyholders. The MediShield Life claim limit for cancer treatment can vary from S$200 to S$9,600, depending on the drug used. To alleviate their medical expenses, cancer patients who hold IPs will likely need to purchase additional insurance riders, which are supplementary to their basic policy.
The cancer drug list has been expanded from 270 treatments when it was first published in August 2021 to 340 treatments as of February this year, covering approximately 90% of all cancer treatments approved by the Health Sciences Authority. The remaining treatments are not included on the Ministry of Health’s (MOH) list due to their cost-ineffectiveness, and suppliers are not willing to lower their prices, as stated by Health Minister Ong Ye Kung in a written parliamentary reply on February 23.
What is the Cancer Drug List
The Cancer Drug List (CDL) is a list of cancer treatments that are approved for MediShield Life, MediSave, and IPs. To reduce healthcare costs, only cancer treatments on the CDL can be claimed under these plans. The CDL includes over 200 approved drugs, which cover around 90% of treatment used by public healthcare institutions. The CDL has been effective for MediShield Life and MediSave since September 1st, 2022, and will come into effect for IPs from April 1st, 2023.
The changes in IP coverage for cancer treatment will be differentiated according to whether the treatments are on the CDL or not. Before September 1st, 2022, MediShield Life paid up to $3,000 per month for all cancer drugs, and IPs often covered costs on an as-charged basis with a small co-payment. However, with the implementation of the CDL, two existing benefits will cease: the broadly applied as-charged benefit for chemotherapy and immunotherapy treatments. Instead, IP coverage of cancer treatment will vary across insurers and depend largely on whether they are on the CDL or not. If a rider was purchased to reduce out-of-pocket expenses, it may cover drug indications beyond the CDL, but the coverage will vary across insurers.
Income, Singlife, and Raffles Health Insurance are three insurers that provide IP riders for non-CDL treatments. While the additional limits of Income riders may seem more attractive, the co-payment percentage required should also be considered. Patients with MediShield Life will only receive additional financial support for their current course of treatment to ensure that their ongoing course of treatment is not disrupted.
For patients who are currently undergoing cancer treatment using drugs not on the CDL and were previously covered as-charged without an IP rider, they may need to discuss with their doctor and consider treatment options on the CDL. Alternatively, they can consider requesting to be directly referred to subsidised specialist care at public healthcare institutions to review their treatment plan and apply for additional financial support if required.
Additional Riders for Cancer Treatment
Prior to the changes on April 1st, seven insurers have either introduced or updated their rider policies to offer additional coverage for cancer treatment.
Presently, the three insurers that provide the best cancer coverage are AIA, Prudential, and Great Eastern. AIA has launched a new Cancer Care Booster that provides coverage of 16 times the amount offered by MediShield Life for cancer drug treatments on the MOH-approved list, in addition to the main policy. Prudential and Great Eastern’s riders provide 15 and 18 times the Medishield Life claim limit respectively, on top of the main policy limit.
The majority of the remaining insurers offer coverage that is at least twice the main IP policy, covering treatments on the cancer drug list and expenses such as consultation fees, tests, and supportive medication. Singlife is an exception, as its rider plan does not specify whether it provides additional coverage for drugs on the MOH list.
For drugs not on the MOH list, Great Eastern has the highest annual claim limit of S$250,000, followed by AIA with S$200,000 and Prudential with S$150,000. The other insurers provide a monthly claim limit of between S$15,000 (Income Insurance) and S$30,000 (HSBC), or S$30,000 per policy year (Singlife).
It remains unclear whether premiums for IP riders will increase after April 1st, as most insurers have not released the information. As of March 31st, only Singlife has revised premium rates for policies starting or renewed from April 1st.
According to its website, Singlife’s annual premiums start at S$27 and go up to S$4,132, depending on the type of plan, for policies beginning or renewed from April 1st. For individuals aged 75 and above, they can only renew their policies and not purchase new ones.
AIA is providing a one-time underwriting waiver for existing policyholders of its private hospital plan who want to take up the new booster, provided they do so within six months of their policy renewal between April 1st and March 31st of next year. The booster comes with an extra premium that starts at S$22.70 and goes up to S$934.90 for individuals over 100 years old.
For the other five insurers, annual premiums for their riders currently range from S$44 to S$12,560, depending on the policyholder’s age and the type of plan they purchase.
Overall, the implementation of the Cancer Drug List aims to reduce healthcare costs by restricting claims for cancer treatments to those on the list. While this may impact out-of-pocket expenses for some, patients can still seek financial support or additional coverage through IP riders or subsidised specialist care at public healthcare institutions.