The government may have to step in to further regulate private healthcare insurance in Singapore if the cost of cancer care continues to escalate.

Addressing concerns raised by several MPs of extremely high rider coverage for cancer treatment, Health Minister Ong Ye Kung said on Friday (Apr 21) that his ministry is “monitoring cancer drug claims and coverage closely”.

If necessary, the Ministry of Health (MOH), together with the Monetary Authority of Singapore (MAS), which regulates insurance companies, will “take further steps to regulate IPs and riders if costs continue to escalate”.

Yip Hon Weng (Yio Chu Kang), one of several MPs raising questions on cancer cost, had asked if high rider coverage will affect the ministry’s efforts to curb rising costs of cancer treatments in Singapore.

Changes to cancer coverage for Integrated Shield Plans (IPs) – offered by private insurers to provide additional coverage on top of the MediShield Life component – came into effect this month.

As a result, these private insurers are allowed to pay only for drugs and treatments on the Cancer Drug List (CDL), and even then, such payments have to be capped. The list was released by MOH in August 2021.

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Riders are meant to pay the bulk of the patient’s share of the bill not covered by the IP. But to continue offering policyholders almost unlimited coverage for all cancer care, several insurers now offer riders that practically pay any price for cancer treatments, including for drugs not on the CDL.

Treatments on the CDL are clinically proven to be effective as well as cost-effective. The changes to cancer financing are an attempt to put the brakes on spiralling costs. Ong said the CDL “is more extensive than similar listings” in most developed countries, including South Korea, Australia and Britain.

He added: “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.”

He said the CDL “sends a strong signal to patients and doctors to use clinically proven and cost-effective treatments”.

He urged people to consider the long-term cost of their insurance products against the level of protection they need. He added: “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.”

He said the price mark-up of cancer drugs by some healthcare providers may be significant, and was encouraged by the previous “as-charged” coverage offered by IPs and riders that provided for “effectively limitless claims”.

With the changes to financing, the high cost of non-CDL 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 costs of non-cost effective drugs will not be socialised”, he said.

Responding to a query from Louis Chua (Sengkang GRC) on whether the new rider coverage for cancer will drive up premiums, Ong noted that such premiums need to be paid in cash and not from MediSave, unlike IPs.

He said now that riders provide higher cancer coverage, their premiums will need to be priced higher. If this results in fewer people buying riders, “I think we have addressed the problem”.

But if riders continue to be in high demand, notwithstanding high premiums, that would be a problem and the MOH and the MAS are prepared to step in.

Giving some background to the need for the change, Ong said more than 30,000 patients receive cancer treatment a year, of whom 84 per cent are treated in the public sector.

“Annual government spending on cancer drug subsidies increased from about US$12 million for about 50 drugs before the CDL announcement in August 2021 to around US$80 million for more than 100 drugs from September 2022.”

With the introduction of the CDL, which became effective in September last year for coverage by MediShield Life and MediSave, and for IPs from April this year, drug companies had reduced their prices – by an average of 30 per cent – so that their drugs can be included in the list.

Ong also told Parliament that any money saved on the purchase of cancer drugs can be ploughed back into more subsidies. THE STRAITS TIMES