After two consecutive increases in its hemodialysis benefit package within a three-month period in 2024, the Philippine Health Insurance Corporation (PhilHealth) announced that total financial assistance has now reached nearly one million pesos per patient annually.
In a statement released on Oct. 14, the state health insurer confirmed the increase in hemodialysis benefits from P4,000 per session in July to P6,350 per session as of October.
Through Circular No. 2024-0023, which took effect immediately on October 7, PhilHealth announced that members and their qualified dependents with chronic kidney disease stage 5 (CKD5) can now access the adjusted hemodialysis package at any accredited dialysis facility in their vicinity.
“This is clear proof that PhilHealth is not only listening to our members,” PhilHealth President and Chief Executive Officer (CEO) Emmanuel R. Ledesma, Jr. said.
“We are fulfilling our promise to take concrete steps to ensure that our benefit packages adequately respond to the needs of patients, which is a core objective of the Universal Health Care Law,” he added.
Ledesma also noted that despite the increase in PhilHealth’s reimbursement rate to P4,000 per session on July 1, they received reports of patients still having to pay substantial amounts for their dialysis sessions.
“Our aim is to ensure that patients will no longer have to make co-payments when availing themselves of the minimum set of services for dialysis,” Ledesma said, acknowledging the PhilHealth Board's swift action on their proposal.
He also acknowledged the collaboration of nephrologists and participating dialysis centers in facilitating the no co-payment arrangement.
PhilHealth stated that with the increase to P6,350 per session, a CKD5 patient is now eligible for maximum financial protection of P990,600 per year, up from the previous P624,000 per year at the P4,000 session rate.
The PhilHealth Circular also explicitly outlines the essential services that must be provided to CKD5 patients.
These services encompass anticoagulation medications, drugs and treatments for managing anemia, various laboratory tests, and supplies such as dialyzers, hemodialysis solutions, and a dialysis kit for each session. Additionally, it covers administrative fees for using dialysis machines, facility fees, utilities, and staff time.
PhilHealth said that all these services should be readily available at all times in both accredited public and private hemodialysis facilities.
Meanwhile, PhilHealth indicated that patients requiring additional or premium services beyond the minimum standard of care outlined in the Circular will be subject to co-payment.
PhilHealth also noted that a cap of P450 for professional fees is established for patients seeking additional services, such as telemedicine or immediate interventions to address complications during a session.
The state health insurer has mandated that dialysis facilities provide a complete explanation of any co-payment arrangements, if applicable.
Dialysis patients, including Roseanne Lappay from Tabacalera in Pateros, welcomed this recent development from PhilHealth.
“Magandang balita para sa aming mga dialysis patient ang pagtaas ng dialysis package na handog ng PhilHealth (The increase in the dialysis package offered by PhilHealth is good news for us dialysis patients),” she said.