PHIC Policy on PNDF Drug Claims

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PHIC PHILHEALTH CIRCULAR NO. 026: PHIC Policy on PNDF Drug Claims

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Title Supreme Court: PHIC Policy on PNDF Drug Claims

Law: Phic Philhealth Circular No. 026

Decision Date: Aug 28, 2000

PhilHealth Circular No. 026 establishes that only drugs listed in the Philippine National Drug Formulary (PNDF) are reimbursable, while also allowing for compensability of certain delisted medications administered during specific confinement periods, effective July 24, 2000.

administrative law

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Dynamism of the PNDF List

The PNDF is subject to updates where drugs and medicines may be added or delisted periodically.
The changes to the list impact which drugs are reimbursable by PhilHealth.

Effectivity Date of the 5th Edition of PNDF

The implementation of the 5th Edition of the PNDF is effective from July 24, 2000.

Compensability of Drugs Not Listed but Approved by BFAD and HTA Committee

Drugs and medicines that are not listed in the PNDF but have been approved by the Bureau of Food and Drugs (BFAD) and the Health Technology Assessment (HTA) Committee are compensable based on PhilHealth's Positive List.

Claims for Delisted Drugs Administered During Confinement

Claims for drugs or medicines that have been delisted from the PNDF but were administered during the confinement period when delisting took effect remain compensable.
Example: If a confinement period spans January 7-15, 2000, and certain medicines were delisted on January 10, 2000, claims for drugs administered during the entire confinement period (January 7-15) are compensable.

Legal Binding and Compliance

The circular establishes clear guidelines to ensure strict compliance on the compensability of drugs relative to their status on the PNDF.
The directive was adopted and signed by the President and CEO of PhilHealth on August 28, 2000.

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