DRUGS ON THE STANDARD LIST

DRUGS ON THE STANDARD LIST: 8.

Mdm Halimah Yacob asked the Minister for Health (a) what criteria are used to determine whether or not a drug is to be listed on the Standard List and how often is this list reviewed; and (b) whether the Ministry can consider higher subsidies for implants instead of the current fixed quantum for patients in the subsidised wards.

Mr Khaw Boon Wan: Our Standard Drug List (SDL) was modelled after the World Health Organization's (WHO) Essential Drug List, with modifications to

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suit local disease profiles and practice. It consists of drugs assessed to be cost-effective and essential to the provision of medical care to all Singaporeans. The assessment is done objectively and professionally by the Drug Advisory Committee (DAC) which comprises a few senior doctors and chaired by the Director of Medical Services.

The DAC, with inputs from other clinicians, reviews the SDL on a yearly basis to take into account changes in clinical practice and advances in medical science. It considers three main factors when determining whether a drug should enter into the SDL:

(i) whether the drug is essential for the treatment of medical conditions that are important causes of morbidity and mortality in Singapore;

(ii) whether the drug offers a major improvement in terms of efficacy and effectiveness, as compared to existing standard drugs; and

(iii) whether there is sufficient evidence of long-term safety and cost-benefits of the drug.

As for implants, we do not have an equivalent standard implant list. Instead, our general policy is to subsidise 50% of the cost of the implant prescribed by the doctor, subject to a cap of $500 per implant. The guideline to our doctors is to prescribe implants that are cost-effective. This is to save money for the subsidised patients.

We review the subsidy cap regularly to ensure that implants remain affordable. Eighty per cent of implants used in the public hospitals cost below $1,000 each. This explains the current subsidy cap.

Mdm Halimah Yacob (Jurong): Sir, I have four supplementary questions to ask

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the Minister. Firstly, given the concerns of our rising healthcare cost, could the Ministry consider covering more medicines under the Standard Drug List? Secondly, there is a fund which pays for non-standard medicines, such as most recently HIV has been included for those who cannot afford to pay for this medicine. Could the Ministry consider expanding the scope of this to cover other medicines as well? Thirdly, could the Ministry also consider increasing the $500 limit imposed for subsidising implants precisely because of rising cost of healthcare? Finally, for the more expensive implants ordered by the doctor, and not by the patient, could the Ministry consider subsidising these implants as well for those who are in the subsidised wards?

Mr Khaw Boon Wan: As I have said, we review the Standard Drug List as well as the subsidy cap regularly. We will revise them when necessary but it has to be based on logic and evidence. Whether we would include more drugs into SDL: if there is justification for it, we will. We have been reviewing the SDL annually. In fact, we are right now in this exercise. The inputs from the doctors are rolling in and the committee will be meeting soon, and we will see.

The special fund that the Member mentioned is the Medication Assistance Fund (MAF) which I introduced last year, precisely to help needy patients who are hit by very expensive but essential drugs which are not yet on the Standard Drug List, subject to means testing. Again, we are in the midst of reviewing the MAF and I may be able to do some adjustments soon.

As for the payment of non-standard items which are ordered by the doctors and for which patients have difficulty in payment: remember our 3Ms. Subsidy is not the only pillar for ensuring

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affordability. There is also Medisave, MediShield and Medifund. And that is why, periodically, I adjust Medisave withdrawal limits and MediShield claim limits to assist patients with that kind of problem. If over and above that, there is a need for Medifund, we will always be sympathetic.