The use of axicabtagene ciloleucel (Yescarta) to treat a specific type of aggressive lymphoma is now supported with subsidies from the Ministry of Health. PHOTO ILLUSTRATION: ISTOCKPHOTO

SINGAPORE – A high-cost drug used to treat a type of aggressive blood cancer has been approved for government subsidies.

Axicabtagene ciloleucel, which is marketed as Yescarta, is a new type of treatment that harnesses cells as “living drugs”.

It is the second such treatment to be subsidised, after tisagenlecleucel, which is marketed as Kymriah.

This provides a lifeline for patients who have not responded to conventional treatments and would otherwise find the drug’s high price tag way beyond their reach.

Responding to queries from The Straits Times, the Ministry of Health (MOH) confirmed that it has added Yescarta to its Cell, Tissue and Gene Therapy Product (CTGTP) List for specific clinical uses.

This comes after a price reduction by the drug manufacturer.

Made from human or animal cells or tissues, or man-made genetic material, CTGTPs can be used to diagnose, treat or prevent a variety of conditions.

The two drugs on the list are assessed to be clinically effective and cost-effective.

Kymriah is used to treat specific blood cancers that have returned after initial treatment or stopped responding to treatment.

Like Kymriah, Yescarta is a type of personalised cancer treatment called chimeric antigen receptor (CAR) T-cell therapy that modifies a patient’s own immune cells (T-cells) to make them more effective at fighting cancer. 

Both are reportedly sold in Singapore at approximately US$375,000 (S$481,000) per treatment.

Eligible patients who need Yescarta can now receive subsidies from MOH. Singapore citizens can receive a subsidy of up to 75 per cent, or $150,000, whichever is lower, while eligible permanent residents can get a subsidy of 22.5 per cent, capped at $45,000. The actual subsidy levels are determined through household means-testing.

Apart from subsidies, patients can also be covered under MediShield Life and can tap their MediSave savings to pay the remaining costs.

The limits have yet to be announced.

At its July 2024 meeting, the MOH Drug Advisory Committee had recommended not to list Yescarta due to an “unacceptable pricing proposal”.

Subsequently, the manufacturer revised its proposal. The committee then recommended that it be included, according to information in the committee’s technology guidance, released by MOH’s Agency for Care Effectiveness.

Yescarta was initially approved for subsidy coverage for patients aged 18 and above receiving the drug as a second-line treatment for diffuse large B-cell lymphoma (LBCL) or high-grade B-cell lymphoma.

This means the patient has already received first-line immunochemotherapy, but relapsed within 12 months or showed poor response and was not responsive to treatment, requiring further treatment with Yescarta.

Yescarta was subsequently approved for subsidies as the third-line treatment of relapsed or refractory LBCL.

LBCL is an aggressive subtype of lymphoma, with diffuse LBCL being the most common. Approximately 300 patients here are diagnosed with diffuse LBCL each year.

MOH estimates that each year, 20 to 30 patients may benefit from Yescarta.

The approval of a second CTGTP comes ahead of the extension of more financial support for treatments on the list. From October 2025, MediShield Life and MediSave coverage will be extended to listed CTGTPs. This is a key shift announced by MOH in 2024, aimed at supporting patients who might otherwise be unable to access these treatments.

Based on information submitted by the drug manufacturer to the MOH Drug Advisory Committee, the impact to the public healthcare system of including Yescarta on the list could be up to $13 million in the first year, and possibly more than $20 million each year by its fifth year of inclusion.

Asked to comment on the impact of listing a second CTGTP on MediShield Life premiums, an MOH spokeswoman said that “no additional premium increases are needed to support the expansion of MediShield Life coverage to new CTGTPs”, under its pilot financing framework.

Singapore General Hospital (SGH) currently has three cancer patients scheduled to be treated with Yescarta.

Dr Chen Yunxin, a senior consultant at SGH’s department of haematology, said that Yescarta has been shown to be superior in treating patients with diffuse LBCL whose cancer had relapsed or stopped responding to treatment, compared to standard treatments.

Acknowledging that without subsidies, such CTGTPs may be out of reach for the vast majority, Dr Chen said: “Approval of this drug in this setting allows this group of patients to have the best chance of survival.”

Kymriah was listed by MOH in August 2024 for the treatment of specific types of leukaemia and lymphoma. MOH said that more than 90 per cent of patients who received it in public healthcare institutions have received subsidies.

Dr Chen said if the lymphoma does not respond to two previous treatments, both Yescarta and Kymriah can be used as a third-line treatment.

Several new cell therapy products have been approved by the US Food and Drug Administration in recent years, with more in the works.