How are MediShield Life claim limits sized when more than one cancer drug is used in the treatment?
In general, the MediShield Life (MSHL) claim limits for cost-effective treatments are set based on the post-subsidy bills for subsidised patients in Public Healthcare Institutions (PHIs).
The Cancer Drug List (CDL) includes treatments that involve a single drug or multiple drugs (i.e. combination treatments). For combination treatments, the applicable MSHL claim limit depends on whether the combination treatment has been assessed to be cost-effective:
- If the combination treatment is cost-effective, the MSHL claim limit is sized to be sufficient to cover the post-subsidy cost of the entire combination in PHIs.
- If the combination treatment is not cost-effective, it may be listed on the CDL subject to negotiations with the drug companies. However, the claim limit would be pegged to the highest individual claim limit of the drugs in the combination. Doctors and patients are encouraged to use treatments that have been assessed to be cost-effective.
