Question & AnswerQ&A (PHIC PHILHEALTH CIRCULAR NO. 036)
The main purpose of PHIC PhilHealth Circular No. 036, s. 2000 is to list additional reimbursable drugs, including over-the-counter drugs, that are included in the Philippine National Drug Formulary and approved for reimbursement by PhilHealth for specific medical conditions.
The diseases with Clinical Practice Guidelines (CPGs) tied to the reimbursable drugs listed in the circular are Hypertension, Urinary Tract Infection (UTI), and Pneumonia.
Claims for Medicare refund for these drugs are reimbursed only when the drugs are used in the treatment of the diseases indicated in the corresponding Clinical Practice Guidelines (CPGs).
The circular classifies certain prescription drugs for Hypertension, Pneumonia, and Urinary Tract Infection as reimbursable under the Positive List.
Yes, the circular approved compensability of certain over-the-counter or non-prescription drugs listed in the Philippine National Drug Formulary.
Examples include Benazepril Hcl, Bisoprolol, Cilazapril, Doxazosin, Isradipine, Ramipril, and Sodium Nitroprusside, all in tablet form.
Pneumonia drugs are listed mostly in vial and tablet or capsule forms, such as Cefamandole (vial), Cefdinir (capsule), and Roxithromycin (tablet).
The circular lists Lomefloxacin and Pefloxacin as reimbursable drugs for Urinary Tract Infection (UTI).
No, the circular lists over-the-counter reimbursable drugs by name only, without specifying dosage forms.
The circular took effect immediately upon its adoption on October 24, 2000.