Question & AnswerQ&A (PHIC PHILHEALTH CIRCULAR NO. 026)
The effectivity date of the 5th Edition of the PNDF is July 24, 2000.
Payments for drugs are made only for those included in the Philippine National Drug Formulary (PNDF), unless an explicit exception is granted by the Corporation (PhilHealth).
Yes, drugs and medicines not listed in the PNDF are compensable if they are approved by the Bureau of Food and Drugs (BFAD) and the Health Technology Assessment (HTA) Committee, based on the PhilHealth Positive List.
Claims for drugs/medicines that were delisted but administered during the confinement period when the delisting took effect remain compensable for that confinement.
Example: If the confinement period was from January 7-15, 2000, and medicines were delisted on January 10, 2000, claims for the delisted drugs administered during January 7-15, 2000, are compensable.
Its purpose is to clarify the effectivity of implementation and compensability of claims for drugs/medicines that are either delisted from or added to the PNDF.
BFAD approval, along with the endorsement of the Health Technology Assessment Committee, is required for drugs not listed in the PNDF to be compensable under the PhilHealth Positive List.
Section 37 of Republic Act No. 7875 provides that payment for drugs shall be made only for those included in the PNDF unless explicit exception is granted by the Corporation.
The HTA Committee evaluates and approves drugs and medicines not listed in the PNDF to determine their compensability under the PhilHealth Positive List.