Why is the MediShield Life claim limit for a particular combination treatment not the sum of all the claim limits for individual drugs in that combination?
If a particular combination treatment is cost-effective, the MediShield Life (MSHL) claim limit is sized to be sufficient to cover the post-subsidy cost of the entire combination in Public Healthcare Institutions (PHIs). In some cases, the claim limit for the entire combination is the same as the highest-cost drug in that combination because the cost of the other drugs in the PHIs are low and can therefore be adequately covered by the same claim limit.
If a particular combination treatment is not cost-effective, the MSHL claim limit is 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, for which MSHL claim limits have been sized for.
