With effect from April 2023, off-label cancer treatments will no longer be covered by your integrated shield plans.
What are integrated shield plans?
Integrated shield plans are insurance products that reimburse the cost of hospitalization and selected outpatient treatments. There are 2,830,000 individuals in Singapore in 2020 that are covered with integrated shield plans. Given there are 4,044,200 Singaporeans and Permanent Residents in 2020, a whopping 70% are covered with integrated shield plans.
Almost all of my clients who bought integrated shield plans from me opted for the highest form of coverage at the private hospitals because they do not wish to be limited by options in the unfortunate event of illness. They also wanted to have full coverage.
Examples of integrated shield plans are:
- NTUC Income Enhanced Incomeshield
- Singlife Shield (formerly known as Aviva MyShield)
- Prudential PRUShield Premier
- Great Eatern GREAT SupremeHealth
- AIA HealthShield Gold Max
- AXA Shield and
- Raffles Shield
What is off-label cancer treatment?
Off label means the use of an otherwise approved drug in a setting for which it has not received regulatory approval. This could be because the drug is still new undergoing trials or it could be because the pharmaceutical company does not think it is worth the expense and effort to seek approval.
How common are off-label cancer treatments
In the United States, a study found that the use of off-label ranges from 18% to 41%. (Source: Off-label drug use in oncology: a systematic review of literature).
Why do oncologists use off label cancer drugs?
The reasons why oncologists use off-label cancer treatments could be because:
- Their patients may have exhausted all lines of approved treatment options;
- Patients have drug intolerance to approved medications;
- Rare tumors may lack of approved drugs evidence;
- Regulatory approvals may be pending for clinical use; or
- Pharmaceutical companies unwilling to pursue regulatory approval due to limited financial incentive for doing so.
What are some real life examples of off-label cancer treatments?
Ms Koh Ee Miang, a 45 year old housewife, was diagnosed in June 2020 for the cancer of the bile duct and it had spread to the liver by the time of diagnosis. Unfortunately, her cancer tested positive for a HER2 protein which made the cancer spread more rapidly.
She started conventional chemotherapy in July 2020. The first choice chemotherapy was ineffective and she started another second choice chemotherapy. However, this did not work either. Oncologists said there was no standard treatment beyond this.
In November 2021, Ms Koh saw a private specialist and started with a cocktail of cancer drugs including an off label drug called Pertuzumab. Ms Koh responded well to the treatment and was able to bring her daughter to Australia in January earlier this year. Unfortunately, Great Eastern rejected the claim for Pertuzumab because the insurer does not cover off-label cancer drugs. Pertuzumab was approved by Health Sciences Authority for treatment of breast cancer but not for the cancer of bile duct.
As a result, Ms Koh decided to skip this drug for one season resulting in the cancer markers shooting up by 50% and her tumor grew. Ms Koh said that she was hoping that she can live long enough to see her daughter grow up. (Source: https://www.ifa.sg/cancer-patient-ends-up-with-33000-bill-after-insurer-refuses-to-pay-for-drug/ )
In another case study is Mr Zhang Chang Hua, 42 years old. Mr Zhang was first diagnosed with cancer when he was just 36 years old. He was healthy and a non-smoker. At that time, the Neuroscience Institute operated on him in 2016. However, in 2018 he had a relapse. He was operated and subject to radiotherapy. All was well after that but the cancer returned in 2020. The cancer returned as “high grade” meaning the cancer can spread quickly. He went for a third operation and had chemotherapy. This time round, the treatment did not work and the doctors suggested a fourth operation before returning to the same regimen of chemotherapy and radiotherapy as there was no more standard treatment.
Mr Zhang decided to turn to private specialist Dr Daniel Chan. Dr Chan prescribed dabrafenib that targets cancer with BRAF V600 mutation which Mr Zhang had. The drug was approved for lung cancer but not brain cancer. Because brain cancer is rare and brain tumors with BRAF V600 mutation is even more rare, it is not likely the drug company will find it economical to apply for registration.
Although his insurer, Prudential, does cover off-label cancer drugs for now, by April 2023, regulation will disallow the insurer from covering this drug.
The cost of this drug is $20,000 per month. The combined income for Mr Zhang and his wife was less than $20,000. Mr Zhang has two sons still in secondary school. His wife said as she choked back in tears: “I have not been able to sleep since I heard about this. I don’t know what else we can do.”
Dr Chan was quoted as saying that with this drug, Mr Zhang has many good years ahead of him. However, Dr Chan has many patients that are on off-label can drugs and he worried what will happen to them when April next year comes.
Here is an interview with Mr Zhang and his oncologist Dr Chan:
Why is the government disallowing off-label cancer treatments from being covered by integrated shield plans?
The MOH wants to limit the use of MediShield and IPs for cancer drugs to those that have been clinically proven to work and are cost-effective.
The compounded annual growth rate for cancer drugs has been growing at 20% per annum as compared to 6% pa for non-cancer drugs. If this current trajectory continues, cancer drug spending is projected to reach a whopping $2.7 billion in 2030.
The Agency for Care Effectiveness found that cancer patients account for only 2% of all patients but cancer drugs constituted a whopping 35% of public sector drug spending.
Is it important to have comprehensive coverage for cancer?
This depends on who you ask.
If you ask the policy makers and those who never had any illness before, they may probably feel that it is not important even to have any form of comprehensive insurance coverage. In fact, they may even feel that it is unimportant to have any form of medical treatments. To them, saving money and minimizing expenditure is more important.
However, if you ask those who are ill or have family members who are stricken with illnesses, they will tell you they regretted not having comprehensive insurance coverage.
As a professional financial planner, insurance is a risk management tool. It has to work together with a comprehensive investment strategy. You get insurance to hedge your wealth against catastrophic illnesses which otherwise would have wiped out your entire wealth. However, you invest so that your wealth can grow much faster than inflation and to offset any cost of living.
Investing without comprehensive insurance is like a person who goes to a battlefield without a defense strategy.
Buying insurance without investment is like having a defense strategy without any offensive strategy.
Just as all militaries have both defensive and offensive strategies, personal financial planning also requires both.
The disallowing of coverage of off-label cancer treatments from integrated shield plan is troubling given the possibility that large percentage cancer drug treatments are off-label. Hence, my suggestion is to consider getting a standalone cancer plan that pays based on diagnosis instead of treatment.
Webinar on Major change in cancer treatments in your integrated shield plans
I will be holding a webinar on this topic. The agenda as follows:
✔️ Update on new regulations limiting the scope of cancer coverage in integrated shield plans
✔️ How common is cancer?
✔️ How treatable is cancer?
✔️ What is the chance of a cancer relapse?
✔️ What is off-label cancer treatment?
✔️ What are examples of cancer claims being rejected and accepted?
✔️ What you should do in view of the limited coverage for cancer in your shield plans?
If interested, do sign up for the webinar at this link: HERE.
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