Lesson 5: Medifund, Medication Assistance Fund & Medication Assistance Fund (Plus)

Key Principles of Medifund Assistance

Personal Responsibility

Patient expected to co-pay to his ability

Medical Necessity

Based on necessity exclude the non-essential choices (Class A, cosmetic surgery, beauty things)

Family Responsibility

use immediate family member's Medisave where possible

Many Helping Hands

Medifund to complement not replace charity fund

encourage philanthropy to provide additional asssitance

Medifund Eligibility Criteria

Singaporean (SC)

Received treatment as subsidized patient (Class B2 or C for inpatient/subsidized outpatient)

Received treatment from Medifun-Approved instituitions

Unable to pay healthcare bills despite receiving government subsidies or etc.

Medifund SIlver

set up a capital sum of $500 million (launched in November 2007 in restructured hospitals and institutions)

Ageing population - decided to carve out a portion of Medifund as Medifund Silver to deliver assistance to needy elderly patients in more targeted manner

Singaporeans 65 years or above

Calculation of Household Income

Sum up the income (including allowances and bonuses but after deducting CPF contributions)

patient himself

immediate family members (parents, spouse, children - regardless of whether they are living together or apart

non-immediate family members staying in the same household

Household Income (HI) = Monthly Per-Capita Household Income (Gross income net of CPF contributions)

Medifund & Medifund Silver Income Guideline

If household income falls below minimum level, patient is eligible for 100% assistance

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Maximum Medifund Assistance

Only Class C patients enjoy 100% Medifund Assistance

Medifund Approval Level

Level 1: Pre-Qualified Cases (Auto)

Level 2: Straight Forward Applications (SF)

Level 3: Non Straight Forward Applications (NSF)

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Medication Assistance Fund (MAF)

Help lower income (not under Level 1 or 2)

Focus on selected clinically-effective medications that may be expensive

Financial coverage for non-standard drugs

Maximum subidy level f 75% upon assessment by Medical Social Service

Per capita Income of $1,500 or less

MAF Eligibility Criteria

Clinical Evaluation - clearly documented in the form

Evidence of Efficacy

Favorable safety Profile

Ethical Consideration - No off label indications and HFA approved indications only

Audits & Checks for MAF

Data will be submitted to MOH

Clinical audits to check on application and approval process

Medication Assistance Fund Plus

Ecpand MAF to cover non-standard drugs

Increase maximum subsidy level from 50% to 75% upon assessment by Medical Social Service

Deducted first before Medisave or Medifund

MAF Plus Eligibility Criteria

Expanding MAF to include NSDL Drugs (MAF+)

Clinically appropriate and deemed clinically necessary for treatment

Qualify for subsidy, patient must have: documented history of non-response or serious side effects to SDL drugs & no other clinical drugs alternatives

Audits & Checks for MAF Plus

Data will be submitted to MOH

Clinical audits to check on application and approval process

All applications are reviewed by MAF Plus Panel and approved by CMB (Chief of Medical Board)