PhilHealth studying possible expanded dialysis coverage

In this file photo, a patient undergoes dialysis at a clinic. (AP)

MANILA, Philippines — The Philippine Health Insurance Corporation (PhilHealth) is studying a proposal to increase its dialysis package to P5,200 per session so that medications needed for the procedure will also be covered.

Eli Dino Santos, PhilHealth executive vice president, said in an interview on Tuesday after meeting with ACT-CIS party-list Rep. Erwin Tulfo that they will study the increase in per session coverage—currently at P2,600.

Santos said this after Tulfo noted that hemodialysis medicines used for the procedure cost around P900 to P1,500 per vial.

“So now, through the efforts of our Cong. Erwin Tulfo, PhilHealth, will study the increase (of the coverage) to P5,200.  We will study this and we are given one month to study this.  And then, we can cover all medicines.  That’s our goal, and that’s the directive of Cong. Erwin Tulfo,” Santos told reporters at a briefing at the Batasang Pambansa complex.

“Our goal is that our dialysis patients will no longer make out of pocket […] With the specifics to the medicine, I have no data about that, but what they usually buy is erythropoietin, which patients usually buy outside of a (hemodialysis) facility.  This is what usually adds up to the expense of patients,” he added.

Tulfo explained that the P2,600 package supposedly includes the medicines, but these are only provided in government hospitals, which means patients have to buy these vials first before getting a hemodialysis treatment.

“Little did we know that it is included in the package of PhilHealth worth P2,600, it is included there but there are hospitals, facilities, and dialysis centers without these medicines.  So what will happen now is that PhilHealth will be given one month to study it, as per the instruction of the Speaker (Ferdinand Martin Romualdez),” Tulfo said.

“We brought this up because there are diabetes patients who told the Office of the Speaker that they are having problems with buying medicines, that’s why they have approached congressmen, mayors, senators.  So to solve this problem what PhilHealth will do is to double the P2,600 package for dialysis, it is now P5,200 so that it will be all-in,” he added.

Santos meanwhile assured that PhilHealth has enough funds for a possible higher benefit provision, with total assets — excluding obligations like outstanding payments to hospitals — amounting to P589.5 billion.

This includes a P463.7 billion reserve fund.

Last June 2023, PhilHealth increased its hemodialysis coverage from 144 sessions to 156 sessions — or twelve more additional sessions.

In November 2023, however, there were proposals to lift the cap on dialysis sessions, given that patients have many expenses.