The Philippine Health Insurance Corporation (PhilHealth) will expand access to selected first-line anti-tuberculosis (TB) medicines through its Guaranteed and Accessible Medications for Outpatient Treatment (GAMOT) program starting Nov. 1.
In a news release Monday, PhilHealth said eligible members and their dependents with confirmed drug-susceptible TB (DS-TB) may obtain covered medicines from PhilHealth-accredited GAMOT facilities through prescriptions issued by YAKAP physicians.
“Importantly, covered anti-TB medicines will not be deducted from the member’s PHP20,000 annual GAMOT benefit limit, preserving this allocation for other covered outpatient medicines,” it said.
Up to a one-month supply of first-line anti-TB medications may be prescribed per transaction. The accredited GAMOT facility must dispense the complete prescribed quantity within two days from the date of GAMOT prescription issuance.
Patients must claim their medicines within the prescribed period. Otherwise, they may still obtain the medicines but must pay out of pocket or secure an updated prescription.
YAKAP-accredited physicians must issue prescriptions through the GAMOT Application in accordance with Department of Health-National TB Control Program treatment protocols.
Before dispensing anti-TB medicines, accredited GAMOT facilities must submit an updated Certification of Availability to their PhilHealth Regional Office (PRO).
PhilHealth will directly reimburse participating GAMOT facilities based on the fixed fees schedule specified in the circular.
“The expanded benefit complements —not replaces — the Outpatient TB-DOTS Package, which remains PhilHealth’s primary benefit for comprehensive outpatient TB care,” it said.
TB-DOTS facilities shall continue providing comprehensive care and dispensing medicines when supplies are available and sufficient.
If first-line anti-TB drugs are dispensed through a GAMOT facility instead of the TB-DOTS facility, an automatic 50 percent deduction will apply to the TB-DOTS package claim for each treatment phase.
PhilHealth encouraged members to consult their YAKAP Authorized Physician or TB-DOTS provider to determine appropriate treatment arrangements and how to access the benefit.
The policy advances comprehensive primary care through the Yaman ng Kalusugan Program, or YAKAP, and supports the Unified National Agenda for Health, particularly its pillar on a functional primary care system.
By connecting primary care consultations with access to prescribed medicines, PhilHealth aims to bridge treatment gaps, promote continuity of care and make health benefits more accessible and responsive to patients’ needs.
“For PhilHealth, strengthening primary care means turning health coverage into meaningful access to care,” it said.
It added that YAKAP and GAMOT advance the national health agenda by expanding access to essential medicines and services, supporting continuous treatment, and reducing financial barriers to care. (PNA)
