Revision to Cancer Drug List and Impact on Integrated Shield Plans' Coverage of Cancer Treatments

Mr Chua Kheng Wee Louis asked the Minister for Health in relation to the Cancer Drug List (CDL), with changes to Integrated Shield Plans (IPs) taking effect from 1 April 2023 (a) what is the number of cancer patients currently on a course of cancer drug treatment based on drugs not on the CDL; and (b) what measures will be put in place for such patients whose IPs’ coverage will cease from 30 September 2023.

The Cancer Drug List (CDL) was introduced to accord the Ministry of Health (MOH) the leverage to negotiate for lower drug prices, thus enhancing the cost effectiveness of cancer treatments in Singapore, and lowering financial burden on patients and families.

How it works is that for a treatment to qualify for inclusion in the CDL, the supplier needs to ensure prices justify the effectiveness of the treatment. Once in the CDL, the treatment will benefit from government subsidy and healthcare insurance claims.

Since announcing the changes in 2021, we have managed to reduce prices of drugs in the CDL by 30% on average, and by over 60% for some drugs. As more suppliers reduce their prices, more drugs are also included in the CDL. The number of treatments in the CDL has increased from 270 when it was first published in August 2021, to 340 as of 1 February 2023. This represents about 90% of all Health Sciences Authority (HSA)-approved treatments.

The rest of the treatments are not in the CDL because the prices do not yet justify the effectiveness, and suppliers are not willing to moderate their prices. But we will continue to work with them in good faith and try to expand the list.

On average, about 90% of patients in private medical institutions and about 95% of patients in Public Healthcare Institutions were on CDL treatments over the period of 1 September to 31 December 2022.

While some patients are undergoing treatment using drugs not on the CDL, most of them continue to be covered by their Integrated Shield Plan (IP) insurance. Insurers have committed to preserve the current IP coverage of policyholders at least until 30 September 2023. Based on the typical duration of cancer treatment, most patients would have completed their treatment with non-CDL drugs by 30 September 2023.

For those whose treatments extend beyond 30 September 2023, there are a few possibilities. One, it is possible that as the CDL continues to expand, it may include their treatment by then. Two, doctors and patients may consider shifting towards CDL treatments that are clinically proven and more cost-effective. Three, if non-CDL treatments continue to be needed, they may still be covered by private insurance products such as IP riders or critical illness plans that they previously purchased. Four, patients who require non-CDL treatments and face affordability issues may opt for subsidised care at Public Healthcare Institutions, where they may apply for additional support such as MediFund.