Law Summary
Legal Basis
- Coverage is pursuant to the Implementing Rules and Regulations (IRR) of Republic Act (RA) 9502, the "Universally Accessible Cheaper Medicines Act of 2008."
- PhilHealth Board Resolution 1214, s. 2009 approves the coverage of P100 drugs for eligible sponsored members.
- The coverage includes drugs listed as P100 drugs beyond the patient's confinement period (take-home medications).
General Rules on Coverage and Limitations
- Initially covers all eligible sponsored members and their qualified dependents.
- P100 drugs are provided during confinement and, when needed, extra packs after discharge with limitations:
- Maximum two weeks full-course treatment for infections using antimicrobial drugs.
- For chronic illnesses, two weeks maintenance dose post-discharge.
- For other acute illnesses, only one extra pack post-discharge.
- Coverage must conform to in-patient benefit limits for drugs and medicines.
- If P100 drugs are unavailable in the accredited hospital/facility, purchase from authorized DOH outlets (e.g., Botika ng Bayan) may be reimbursed upon submission of official receipts.
- Administration and claims of P100 drugs must be appropriate, necessary, and comply with rational drug use, CPGs, and ethical medical practice.
- Unused P100 treatment packs upon discharge are reimbursable subject to benefit ceilings.
- Example: Full reimbursement of drugs dispensed even if not all consumed during confinement.
Eligibility
- All sponsored members and qualified dependents with confinement dates within active membership validity as shown on ID or Member Data Record are eligible.
Claims and Availment Procedures
- No separate claim form for P100 drugs; incorporated in Claim Form 2 part III for in-patient services.
- Claims must specify generic name, brand, dose, quantity, unit price, actual charges, and delineate benefits to hospital and member.
- P100 drugs purchased outside hospital from DOH-authorized outlets during confinement may be reimbursed upon attaching official receipts.
- Claims must be filed within 60 days post-discharge.
Effectivity
- Policy is effective for admissions starting June 1, 2009.
Additional Notes
- This Circular is the initial implementing guideline for PhilHealth Board Resolution 1214 s. 2009.
- Further circulars will be issued in accordance with the provisions of the PBR and the IRR of RA 9502.
- List of P100 drugs is attached in annex (not filed with ONAR).