PhilHealth increases dialysis coverage to almost P1 million per year

INQUIRER FILE PHOTO / GRIG C. MONTEGRANDE

CEBU CITY, Philippines — State health insurer PhilHealth has implemented two successive increases in its benefit package for hemodialysis from P4,000 in July to P6,350 per session this October, making the total financial package to almost a million pesos per patient per year.

Through PhilHealth Circular No. 2024-0023, which immediately took effect on October 9, 2024, members and their qualified dependents with chronic kidney disease stage 5 (CKD5) can now avail of the adjusted package for hemodialysis from any of the accredited dialysis facilities near them.

It was he second increase in hemodialysis coverage extended by PhilHealth in a span of just three months this year.

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“This is clear proof that PhilHealth is not only listening to our members. We make good on our promise to take concrete steps to ensure that our benefit packages respond adequately to the needs of patients which is a core objective of the Universal Health Care Law,” said Emmanuel R. Ledesma, Jr., PhilHealth’s President and Chief Executive Officer.

Ledesma pointed out that despite the increase in PhilHealth reimbursement rate of P4,000 per session on July 1 this year, they have received reports of patients still paying significant amounts for their dialysis sessions.

“Our aim is to ensure that patients will no longer have co-payment when availing of the minimum set of services for dialysis. Ito ay para lubos na maramdaman ng mga kababayan natin ang kanilang PhilHealth benefit,” explained Ledesma, duly recognizing the PhilHealth Board’s swift action on their proposal: “Sa pamumuno ni Health Sec. Ted Herbosa, mabilis naaprubahan ang pagtaas sa P6,350 per session na walang dagdag-bayad sa mga pasyente.”

The PhilHealth chief also cited the cooperation of nephrologists and participating dialysis centers in making the no co-payment arrangement possible.

With the increase to P6,350 per session, a CKD5 patient is now entitled to a maximum of P990,600 in financial protection per year, from the previous P624,000/year at P4,000 per session.

The said Circular also clearly specified the essential services required and should be provided to CKD5 patients. This includes anti-coagulation medications and drugs and medicines for the management of anemia, various laboratory tests, supplies such as dialyzers, hemodialysis solutions, and a dialysis kit per session.

It also includes administrative fees for the use of dialysis machines, facility fee, utilities, and staff time. All these services should be accessible at all times in all accredited public and private hemodialysis facilities.

Meanwhile, patients who will require additional and premium services beyond the minimum standard of care specified in the said Circular shall be subject to co-payment. A cap of P450 for professional fees is also set should patients require additional services such as telemedicine and/or immediate interventions to manage complications arising during session. The state health insurer has made it a requirement for the dialysis facility to fully explain any co-payment, if any.

This life-saving service has given new hope to dialysis patients like Roseanne Lappay of Tabacalera, Pateros who welcomed this recent development at PhilHealth.

“Magandang balita para sa aming mga dialysis patient ang pagtaas ng dialysis package na handog ng PhilHealth.”

For his part, Ledesma assures all PhilHealth members here [in the country] and even those overseas, “Kapag ipinangako namin, ginagawa po namin sa PhilHealth. Kaya ang panawagan ko sa lahat ng Pilipino, huwag na po kayong matakot sa pagpapagamot dahil sagot kayo ng PhilHealth!”