Medication Assistance Fund

The Medication Assistance Fund (MAF) was set up by the Ministry of Health (MOH) in August 2010 to help patients pay for non-basic drugs (eg. expensive medication, including certain cancer drugs) provided they met certain clinical indicators pre-determined by the Ministry. The fund was apportioned to healthcare institutions to administer.

In 2011, the MAF scheme was expanded to the MAF Plus scheme, where instead of an MOH pre-determined list, the new scheme allowed each institution to determine for itself, through a specific set of guidelines and a peer-review mechanism, whether a non-basic drug should be subsidised under the fund. This arrangement conferred broader discretion to each healthcare institution and provided more flexibility in recognition of the fields of specialisation of each institution, particularly the specialist disease centers.

In the MAF Plus scheme, only doctors who were consultants in seniority and above were allowed to apply for subsidies for their patients, in collaboration with the medical social worker. Applications must be endorsed by the relevant Heads of Department and approved by a committee chaired by the Chairman of Medical Board (CMB), or equivalent. The committee would review the scientific evidence provided by the doctor, who must also specify that all standard alternatives had been thoroughly considered and commited to the drug’s clinical effectiveness.

What was lacking though, was a systematic approach that tackled the issue of rare diseases, such as the case of haemophilia with inhibitors. For example, the Western Australian Department of Health was then developing a state strategy for rare diseases and the National Rare Diseases Working Group convened by the Australian Paediatric Surveillance Unit (APSU) was also preparing a draft for such a nation-wide strategy. In Japan, the Specified Disease Treatment Program (or “Tokutei Shikkan Chiryo Kenkyu Jigyo”) was studying not only the impact of rare diseases in Japan, but also subsidised medical care for patients with rare and intractable diseases. Such an approach could be helpful for Singapore to study the short and long-term impact of rare diseases on her constituents and to also devise strategies that tackle issues of research, clinical practice and financial sustainability in this area. The peer-review process that applications were subjected to within the MAF Plus scheme was a good starting point, and the next step would be to convene a working group similar to the APSU and to consider a subsidy strategy that was allocated to a specific disease instead of a specific drug, in addition to other longitudinal research strategies.

In 2012, the MOH enhanced subsidies under the MAF because some patients, especially those with less common diseases or complex conditions, may not respond well to standard drugs. The MAF was expanded to cover other non-standard drugs if they were assessed to be clinically necessary and appropriate for the treatment of the patients’ conditions. Hospitals accordingly put in place a framework to assess patients’ needs for the drug on a case by case basis. The level of subsidy provided under the MAF was also increased from 50% to 75% for needy Singaporeans.

The MAF and MAF Plus schemes are still evolving, having been the fruits of a Standard Drug List (SDL) Gap Analysis Project in 2007 undertaken by the Pharmacoeconomics and Drug Utilisation Unit (PEDU) within MOH, and they are likely to continue to change to meet the future healthcare needs of the nation. From a health systems point of view, they offer a glimpse of what is possibly an approach to decision-making on high-cost medicines and interventions.

=See also=
 * PrEP in Singapore
 * HIV/AIDS in Singapore

=References=
 * https://www.asiabiotech.com/19/1904n05/1904n050042x.html
 * https://www.moh.gov.sg/news-highlights/details/drug-subsidy-applications-and-medication-assistance-fund-plus-scheme/
 * https://www.moh.gov.sg/cost-financing/healthcare-schemes-subsidies/drug-subsidies-schemes

=Acknowledgements=

This article was written by Roy Tan.