MANILA, Philippines — The Philippine Health Insurance Corp. will expand access to selected tuberculosis medicines starting Nov. 1, allowing eligible members and their dependents to obtain the drugs without drawing down their annual outpatient medicine benefit.
The coverage applies to patients with confirmed drug-susceptible tuberculosis who receive prescriptions from physicians under PhilHealth’s Yaman ng Kalusugan Program, or YAKAP, the insurer said Monday.
Patients can obtain the covered first-line medicines at accredited facilities participating in the Guaranteed and Accessible Medications for Outpatient Treatment program, known as GAMOT. The drugs will not count against a member’s annual GAMOT benefit limit of 20,000 pesos.
Physicians may prescribe up to a one-month supply per transaction. Participating facilities must dispense the full prescribed quantity within two days of the prescription’s issuance.
Patients who miss the deadline must obtain an updated prescription or pay for the medicines themselves, PhilHealth said.
YAKAP-accredited physicians must issue prescriptions through the GAMOT application and follow Department of Health treatment protocols.
The expanded coverage supplements, rather than replaces, PhilHealth’s outpatient tuberculosis treatment package, known as TB-DOTS, which remains its primary benefit for comprehensive outpatient TB care.
TB-DOTS facilities will continue providing care and dispensing medicines when supplies are sufficient. If a patient receives first-line TB medicines through a GAMOT facility instead, PhilHealth will automatically reduce the TB-DOTS facility’s claim by 50% for each treatment phase.
Before dispensing the medicines, GAMOT facilities must submit an updated certification of availability to their PhilHealth regional office. The insurer will reimburse participating facilities directly according to a fixed fee schedule.
PhilHealth urged members to consult their YAKAP physician or TB-DOTS provider about treatment arrangements and access to the medicines.
