Healthier SG Chronic Tier and Subsidised Drugs Programme Coordinating Information for all clinics

The Healthier SG Chronic Tier comprises 2 components:

Means tested percentage subsidies (e.g. x %) for whitelisted drugs.
• There is no dollar cap on the subsidies.
• Whitelisted drugs will be subject to price caps¹.
Dollar subsidies (e.g. up to $y per visit, capped at $z per year) for other care components of the bill (i.e. consult, investigations, non-whitelisted drugs, others)
• The per-visit limits will remain unchanged from the existing CHAS Chronic Tier
• The annual limit will be adjusted from the existing CHAS Chronic Tier annual limits, as there are uncapped subsidies for the whitelisted drugs via component 1.

Healthier SG enrollees who are CHAS/Pioneer Generation/Merdeka Generation cardholders have the option to choose between the existing Community Health Assist Scheme (CHAS) Chronic Tier or Healthier SG Chronic Tier for each visit at their enrolled clinic.

Please note that only 1 subsidy framework can be used at each visit.
The remaining annual balance will be pro-rated when there is a switch between subsidy framework at the next visit, to account for the difference in annual limits between the two tiers.

2. Healthier SG Medication List (also referred to as the "Whitelist")

Please click here for the Healthier SG whitelist.

3. Preparation

(i) Healthier SG clinics are required to offer subsidised drugs

As a Healthier SG clinic, you are required to make Healthier SG whitelisted drugs available to Healthier SG enrollees who are CHAS, Pioneer Generation (“PG”) and Merdeka Generation (“MG”) cardholders and to provide subsidies for these whitelisted drugs to these enrollees. To facilitate Healthier SG clinics in offering subsidised drugs to the enrollees, your clinic will be required to onboard a Healthier SG compatible clinic management system (CMS) which is one of the IT requirements for Healthier SG clinics.

Clinics are strongly encouraged to either (i) apply for Order Management System (OMS) account with ALPS and (ii) obtain a Direct Debit Authorisation (DDA) with ALPS (authorisation by banks) to utilise direct patient delivery (DPD) of subsidised drugs, which reduces the need for onsite inventory management and/or (iii) completing the Singapore Drug Dictionary (SDD) mapping for use of privately procured drugs.

Offering subsidised drugs through manual processes especially when you are not onboarded a Healthier SG-compatible CMS would increase your administrative workload and may increase your risk of breaching clauses stated within the General Practitioners Letter of Agreement (GP LOA).

(ii) Procurement arrangements

Apart from your existing private arrangements, Healthier SG GPs have the option to tap on Healthier SG special pricing agreements to purchase the whitelisted drugs, via the following sources:

(a) ALPS

i. Bulk purchase:

For the 184 whitelisted drugs which are supplied by ALPS, GPs may purchase from ALPS for delivery to clinics.

Bulk Purchase from ALPS (before GST)	Total order below $100	Total order above $100
Delivery charges (before GST)	$20	No delivery charges

ii. Direct Patient Delivery (DPD):

Healthier SG GPs may tap on ALPS’s direct patient delivery option for the drugs supplied by ALPS to be delivered to patients’ homes.

DPD	1^st delivery	1^st redelivery	2^nd redelivery
Delivery charges (before GST)	$20	No delivery charges	$8 (waived for a start)

Healthier SG GPs must be on a Healthier SG-compatible clinic management system (CMS) published in the January 2024 listing to enjoy the option of the direct patient delivery offered by ALPS. There are no web portals that support direct patient delivery.

(b) Specific pharmaceutical companies:

i. For the 23 whitelisted drugs which are supplied by the specific pharmaceutical companies under special pricing agreements, GPs may purchasing them from the pharmaceutical companies.

ii. Pharmaceutical companies have been informed to maintain their existing means of distribution to Healthier SG GPs. If there is no existing representative liaison, please reach out to the pharmaceutical company with the contact details provided alongside the Whitelist.

(iii) To whom can the whitelisted drugs be prescribed to?

The table below summarises who you can prescribe the whitelisted drugs to, which depends on the procurement source:

Drugs procured from ALPS can only be sold to Healthier SG enrollees of your clinic.
Drugs procured from other sources (including the specific pharmaceutical companies under special pricing agreements) can be sold to any patients.

Type of patient	Healthier SG Special Pricing Agreements		Own private arrangements
Type of patient	ALPS	Specific Pharmaceutical companies	Own private arrangements
Healthier SG Enrollee²	✓	✓	✓
Non-Healthier SG Enrollee	X	✓	✓

(iv) Procurement of whitelisted drugs from ALPS

Procurement of Whitelisted Drugs from ALPS.png

(a) Register for an Order Management System (OMS) account with ALPS via https://oms.alpshealthcare.com.sg/

Clinics should comply to ALPS Term of Sales (TOS).
Healthier SG clinics who wish to place bulk purchase or direct patient delivery with ALPS, will need to register for an account with ALPS on OMS.
Registration may take up to 3 working days.

(b) Direct Debit Authorisation (DDA) to be approved and authorised by the bank

Mandatory for clinics who wish to use Direct Patient Delivery (DPD).
Submit DDA over OMS and authorised by bank.
DDA approval is subject to bank approval and may take longer than 10 working days.

(iv) SDD code mapping – NEHR Onboarding for Healthier SG Clinics

GPs will need to complete the mapping of drug names to SDD which will be essential in the contribution of clinical records to NEHR, a core responsibility of Healthier SG GPs as set out in the Healthier SG Enrolment Programme Agreement.

With SDD drug mapping completed, GPs can then tap on a centralised drug charge code map provided by MOH/Synapxe to facilitate computation of price caps and submission of Healthier SG claims. This reduces the administrative burden on GPs to manually calculate bills and submit claims.

The actions to be taken by GPs for SDD mapping are dependent on the procurement source of the whitelisted drugs under the selected list of chronic medications for CDMP conditions:

S/N	Source of drugs under the selected list of chronic medications for CDMP conditions	Actions to be taken by GPs
1	Orders for Direct Patient Delivery via Healthier SG-compatible CMS	SDD mapping for ALPS’s supplied drugs under the selected list of chronic medications for CDMP conditions has been provided to CMSes and mapped centrally. GPs are not required to perform SDD mapping.
2	Bulk purchases from ALPS via ALPS OMS	The SDD codes are mapped centrally for ALPS’s supplied drugs under the selected list of chronic medications for CDMP conditions and made available in the CMSes. GPs are not required GPs to perform SDD mapping for these drugs. However, SDD mapping is required for all remaining drugs (drugs under the selected list of chronic medications for CDMP conditions and drugs for non-CDMP conditions) in GP’s existing drug inventory in the Healthier SG-compatible CMS, for NEHR contribution purposes. This needs to be done by clinics. This includes any new drug purchased from non-ALPS sources in the future, including those from pharmaceutical companies under MOH’s Special Pricing Arrangements. Note: If SDD mapping for all remaining drugs is not done, the Healthier SG clinic can still use ALPS’s Direct Patient Delivery services. However, price caps will not be auto-populated for unmapped drugs dispensed at the counter.
3	Purchases from specific pharmaceutical companies under MOH Special Pricing Agreements or other private arrangements	Clinics need to enter the drugs into their inventory. For drugs under the Healthier SG Medication List that are purchased from MOH specified pharmaceutical companies or other private pharmaceutical companies, these will need to be mapped in the CMS for price caps to be auto-populated. GP will need to search for the drug in the ‘Ambulatory subset with Healthier SG Whitelist Indicator for GP’ list for the SDD codes.

The drug lists and the mapping table for price caps have been given to CMSes to create the backend logic to compute the subsidy and bill.

GPs should complete SDD mapping of all the drugs in its inventory as soon as possible. Inventory set up is essential especially for clinics not utilising Direct Patient Delivery. Thus, it is important for clinics to be able to differentiate the whitelisted drugs procured from different procurement sources, which needs to be clearly labelled for the correct price caps to apply. If the GP is unable to complete SDD mapping by the 1^st February 2024 launch, the GP may use the Direct Patient Delivery module in their CMS, to order the drugs under the selected list of chronic medications for CDMP conditions from ALPS.

However, as part of the Healthier SG IT requirement, clinics must adopt a Healthier SG-compatible CMS by 8^th July 2024, otherwise the following enforcement actions will take place: i. the Clinic will not be able to take in new enrollees from 8^th July 2024; and ii. If the clinic has still not adopted a Healthier SG-compatible CMS by 8^th October 2024, it will be removed from the Healthier SG programme.

In addition, the failure to contribute to NEHR means that other care providers will not be able to view pertinent health information and treatment done at Healthier SG clinics. This will affect shared care, care continuity, and patient safety. SDD mapping is needed for NEHR contributions and failure for NEHR contribution by 8^th October 2024, will put clinics at risk for not complying with Healthier SG IT requirements, leading to offboarding from the Healthier SG programme.

Here are some examples of how clinics can differentiate between whitelisted drugs procured from different procurement sources by labelling their inventory:

(a) Whitelisted drug of the same brand from different procurement sources	Add a suffix behind the drug description indicating the procurement source of drug.
	Insulin Glargine (Lantus) 100 international units/mL Injection, prefilled pen*_Pharma under SPA* Insulin Glargine (Lantus) 100 international units/mL Injection, prefilled pen*_private arrangements*
(b) Whitelisted drug of different brands by different procurement sources	Include the different brand names. Add a suffix behind the drug description indicating the procurement source of drug.
	Betamethasone 0.025% cream (Brand A)_ALPS Betamethasone 0.025% cream (Brand B)_private arrangements

(v) SDD mapping support

Should you need support for SDD mapping, there are several options available:

(a)

SDD standard workshop

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SDD Standard workshop is scheduled every Monday from 4:00pm to 5:00pm to provide support on how to do SDD code mapping. Please contact nehr.onboarding@synapxe.sg to sign up for workshop.

Patient Visits

Thus, it is important that you discuss the choice of subsidy tier with your patient. To facilitate your discussion with your patient, CMS vendors have been asked to provide the option to select which subsidy framework to use to make available at each visit. The subsidy amount to be claimed would be automatically calculated according to the subsidy framework selected. Computation of the remaining annual balances under the existing CHAS Chronic Tier or new Healthier SG Chronic Tier will be automatically done backend, according to the subsidy framework selected. Do approach your respective CMS vendors should you have any questions.

Management of Patient Queries

Queries from patients/ residents via the call centers in MOH’s Contact Centre Network (CCN) will be triaged to the relevant stakeholders:

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Clinical queries: contact the GP for advice.