List of Reimbursable Drugs for Hypertension
- Includes various antihypertensive agents primarily in tablet form.
- Examples: Benazepril Hcl, Bisoprolol, Cilazapril, Doxazosin, Isradipine, Lacidipine, Manidipine Hcl, Perindopril, Quinapril, Ramipril, Delapril, Lisinopril, Carteolol, Oxprenolol, Pindolol, Guanfacine, Sodium Nitroprusside, Nitrendipine.
List of Reimbursable Drugs for Pneumonia
- Covers a range of antibiotics in various forms such as capsules, tablets, and vials.
- Examples: Cefamandole, Cefoperazone, Cefotiam, Cefpirome, Cefdinir, Co-amoxyclav, Cefprozil, Ceftibuten, Ceftizoxime, Dirithromycin, Roxithromycin, Sultamicillin, Cefaclor, Cefetamet, Levofloxacin.
List of Reimbursable Drugs for Urinary Tract Infection (UTI)
- Contains antibiotic agents recognized under the CPG for UTI treatment.
- Examples: Lomefloxacin, Pefloxacin (both tablets).
Over-the-Counter (OTC) Drugs Approved for Compensability
- PhilHealth compensates for selected non-prescription drugs listed in the Philippine National Drug Formulary.
- The OTC drugs cover various treatment categories such as antacids, pain relievers, antihistamines, topical agents, laxatives, vitamins, and other symptom relief medications.
- Representative drugs include Aluminum Hydroxide, Aspirin, Benzoyl Peroxide, Calamine, Ibuprofen, Ketoconazole, Loperamide, Loratadine, Paracetamol, Phenylephrine Hcl, Pyrantel Pamoate, Ranitidine, Sodium Bicarbonate, Sulfur, among others.
Conditions for Reimbursement
- Reimbursement claim is valid only when the approved drugs are used for the diseases and conditions specified within the Clinical Practice Guidelines.
- This ensures medical appropriateness and adherence to standardized treatment protocols.
Legal Effectivity
- The Circular took effect immediately upon adoption on October 24, 2000.
- Signed by Enrique M. Zalamea, President and CEO of PhilHealth at the time.
Important Legal Concepts
- Positive List: Drugs approved for coverage and reimbursement by PhilHealth.
- Clinical Practice Guidelines (CPGs): Evidence-based protocols guiding appropriate drug use.
- Medicare Refund: Financial reimbursement for beneficiary drug expenses when criteria are met.
- Philippine National Drug Formulary: Official government list of approved drugs in the Philippines, serving as basis for coverage decisions.
- Over-the-Counter Drugs: Non-prescription medications that are nonetheless compensable when listed and approved in the Formulary.