PhilHealth breast cancer coverage now at P1.4 million

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Philippine Health Insurance Corp. (PhilHealth) has raised the benefit package for the treatment of breast cancer, the most prevalent cancer among Filipino women, to more than P1 million.

The coverage for breast cancer under the state insurer’s “Z Benefits” package has gone up significantly, from a measly P100,000 to P1.4 million, up by 1,300 percent, PhilHealth president and CEO Emmanuel Ledesma Jr. said.

The increase was approved by the PhilHealth board in February, but it will take effect this month in celebration of National Women’s Month.

According to Ledesma, the previous P100,000 package for breast cancer was being “laughed at” even by some government officials, for being so low there was no real benefit to the patient.

“Breast cancer is really very common with everyone. That 14 times increase, I think that’s just one of the accomplishments [of PhilHealth] that can put a smile on the face of the Filipino people,” he said.

PhilHealth’s Z benefit package for breast cancer, however, is only available at 18 hospitals across the country—two of which are in Metro Manila: East Avenue Medical Center in Quezon City, and Philippine General Hospital in Manila.

The Z benefit packages are services and rates for “Case Type Z,” or catastrophic illnesses that could result in prolonged hospitalization and poor outcomes without early intervention.

This typically includes hospital room and board fees, in-hospital medications, laboratory examinations, operating room fees, and professional fees.

According to data from the World Health Organization (WHO), breast cancer is the most common cancer among Filipino women and in the world.

Over 9K deaths in 2020

One in every 100 Filipino women will be diagnosed with breast cancer in their lifetime, the WHO data showed.

In 2020, there were 27,163 new breast cancer cases in the country, and 9,926 Filipinos died of the condition.

In the same year, breast cancer recorded the third-highest mortality rate among cancers at 17.7 percent, following lung cancer (18.4 percent) and liver cancer (10.7 percent).

According to Renato Limsiaco Jr., PhilHealth senior vice president for fund management sector, the state insurer allocated P261 billion for benefit packages in 2024, bearing the increase of 30 percent in almost all of its existing case rates effective on Feb. 14, to account for price changes since 2013 when most case rates were last adjusted.

Of the 14 benefit packages for catastrophic cases, four have been increased beyond 30 percent. Significant increases in 10 more catastrophic cases are set to be implemented this year and in 2025.

“We plan to increase many of our benefit packages beyond 30 percent as ordered by the President … We need this additional income so that in the next coming years, if we ever further increase our benefit packages, we will have enough funding to do it,” Limsiaco said.

In June last year, PhilHealth increased the number of hemodialysis sessions covered by its package for Stage 5 chronic kidney disease patients from 90 to 156 sessions a year—or from P234,000 to P406,500 at P2,600 per session, equivalent to a 74-percent increase.

In October last year, PhilHealth also increased the coverage for ischemic stroke from P28,000 to P76,000 (up by 171 percent), and hemorrhagic stroke from P38,000 to P80,000 (an increase of 111 percent).The coverage for high-risk pneumonia was also raised from P32,000 to P90,100 (up by 182 percent).