Need TB medicines? PhilHealth expands coverage without tapping ₱20,000 drug limit

National

STARTING Nov. 1, eligible tuberculosis patients can get selected anti-TB medicines through the Philippine Health Insurance Corp. (PhilHealth) without using up their annual ₱20,000 outpatient drug benefit.

The expanded coverage falls under PhilHealth’s Guaranteed and Accessible Medications for Outpatient Treatment (GAMOT) program, pursuant to PhilHealth Circular No. 2026-0018.

“Eligible patients with confirmed drug-susceptible tuberculosis (DS-TB) may obtain covered medicines from PhilHealth-accredited GAMOT facilities through prescriptions issued by YAKAP (Yaman ng Kalusugan) physicians,” PhilHealth said in a press release.

Under the policy, prescriptions must be issued through the GAMOT app by physicians accredited under the YAKAP program, in accordance with the Department of Health’s National Tuberculosis Control Program treatment protocols.

Eligible patients may receive up to a one-month supply of prescribed first-line anti-TB medicines per transaction. Accredited GAMOT facilities are required to dispense the full prescribed quantity within two days from the issuance of the prescription.

Patients who fail to claim their medicines within that period may still obtain them, but must secure an updated prescription or pay for the medicines themselves.

Before dispensing the drugs, GAMOT facilities must also submit an updated certificate of availability to their designated PhilHealth regional office.

PhilHealth will reimburse accredited facilities directly based on fixed fees. The cost of covered anti-TB medicines will not be charged against the program’s annual ₱20,000 benefit limit, allowing the allocation to remain available for other outpatient medicines.

The expanded coverage supplements the existing tuberculosis-directly observed treatment, short-course (TB-DOTS) package, which provides comprehensive outpatient care for TB patients.

TB-DOTS facilities will continue to provide comprehensive care and dispense anti-TB medicines, depending on the availability of supplies.(MyTVCebu)