PhilHealth expands access to anti-TB medicines via GAMOT

MANILA, Philippines, October 21 ------ The Philippine Health Insurance Corp. (PhilHealth) is expanding access to selected first-line anti-tuberculosis (TB) medicines through its Guaranteed and Accessible Medications for Outpatient Treatment (GAMOT) program.

The expanded benefit will take effect on Nov. 1, giving eligible patients additional access to prescribed TB medicines, according 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.

The covered anti-TB medicines will not be deducted from the annual GAMOT benefit limit of P20,000, preserving the allocation for other outpatient medicines, PhilHealth said. Under the policy, YAKAP-accredited physicians must issue prescriptions through the GAMOT Application in line with the Department of Health’s National TB Control Program treatment protocols.

Patients may receive up to a month’s supply of first-line anti-TB medicines per transaction. Accredited GAMOT facilities must dispense the full prescribed quantity within two days of the prescription’s issuance. Patients who fail to claim their medicines within the prescribed period may still obtain them but must pay out of pocket or secure an updated prescription.

GAMOT facilities must also submit an updated Certificate of Availability to their designated PhilHealth Regional Office before dispensing anti-TB medicines. PhilHealth will directly reimburse the facilities based on fixed fees. The expanded benefit allows eligible patients to obtain prescribed anti-TB medicines through accredited GAMOT facilities, complementing the existing TB-DOTS package for comprehensive outpatient care.

TB-DOTS facilities will continue to provide comprehensive care and dispense anti-TB medicines, subject to available supplies. However, the TB-DOTS package claim for each treatment phase will be reduced by 50 percent if the medicines are obtained through a GAMOT facility instead. “PhilHealth aims to help bridge gaps in treatment, promote continuity of care, and make health benefits more accessible and responsive to patients’ needs,” PhilHealth said.

Source: inquirer.net