Patient Access, Financing Options and Reassessment Framework for Cell, Tissue and Gene Therapy Products Not Recommended for Subsidy by ACE

Mr Low Wu Yang Andre asked the Coordinating Minister for Social Policies and Minister for Health where a Cell, Tissue and Gene Therapy Product (CTGTP) is not recommended by the Agency for Care Effectiveness (ACE) for subsidy (a) what alternatives exist for managed access or financing; (b) what change in circumstances will trigger reassessment; and (c) what roles the ACE, mainstream financing schemes and Rare Disease Fund play in the access, financing and reassessment of CTGTPs.

The Ministry of Health (MOH) uses internationally-established Health Technology Assessment (HTA) processes to inform mainstream funding decisions, including for cell, tissue and gene therapy products (CTGTPs). As a small market Singapore tends to lack negotiating power and HTA instills the discipline to ensure that the price of drugs and medical devices we procure is commensurate with their clinical value. It helps ensure that Government subsidies and insurance payouts are directed towards treatments that bring value to patients, while keeping our healthcare spending and premiums sustainable. HTA is conducted by the Agency for Care Effectiveness, which although part of MOH, carries out their work independently based on expert assessment.

Typically, for a drug that is assessed to be non-cost effective, we will need to negotiate with manufacturers to price these therapies more affordably and commensurate with the benefits they provide.

We have good success in doing this. But if price adjustment is still not forthcoming, patients who require CTGTPs may have access to other avenues of financial support, including private health insurance or discretionary assistance through MediFund in public health institutions. The Rare Disease Fund and other charities may also support selected treatments for rare diseases under their own criteria.