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(NAR) VOL. 15 NOS. 3-4 / JULY / SEPTEMBER

[ PHIC PHILHEALTH CIRCULAR NO. 26, S. 2004, November 15, 2004 ]

REIMBURSEMENT OF CLAIMS FOR DRUGS LISTED IN THE PNDF VOLUME ONE, SIXTH EDITION-SECTIONS 2, 7, 8, 13, 14 AND 15



The National Formulary Committee of the Department of Health has released the official list of drugs under the following sections: 2.0 Drugs Affecting the Muskuloskeletal System and Joints, 7.0 Respiratory Drugs, 8.0 Anti-Allergics, 13.0 Gastrointestinal Drugs, 14.0 hormones and Hormone Antagonists and 15.0 Drugs Acting on the Uterus of latest edition of the Philippine National Drug Formulary (PNDF) Volume One (1), sixth (6th) edition, as approved by the Secretary of Health.

Pursuant to Section 37 of Republic Act 7875 and PhilHealth Board Resolution No. 265 s. 1999 which provides for the use of the latest edition of the PNDF for reimbursement, the said list of drugs shall be implemented as follows:


  1. Newly listed drugs and drug preparations that are now included in Section 2.0, 7.0, 8.0, 13.0, 14.0, and 15.0 of the PNDF, Volume 1, 6th edition (Annexes 1-6), shall be compensable for claims with discharge dates starting December 1, 2004.

  2. Denial of PhilHealth coverage or reimbursement of delisted drugs and drug preparations for the above mentioned sections of the PNDF shall be held in abeyance pending the completion of the entire PNDF list and provision of reasons for the deletion of the same by the National Formulary Committee.

  3. Clarification is also made here that bupivacaine injection 0.5% 4 mL ampul with 8% dextrose (as hydrochloride) which is included in the newly listed drug preparations as per PhilHealth Circular No. 03, s. 2004 Annex 1 (Section 1.0 Drugs Acting on the Nervous System) is the same as bupivacaine injection 0.5% (heavy), 4 mL ampul (spinal) (as hydrochloride).

The latter preparation of bupivacaine which does not appear in the 6th edition of the PNDF is not a true delisting but rather a renaming whereby the NFC has removed the word "heavy" and instead added the words "with 8% dextrose".

In view of this, we are amending PhilHealth Circular No. 03, s. 2004 Annex 2 (Text available at the ONAR, UP Law Center) (Section 1.0 Drugs Acting on the Nervous System) where bupivacaine injection 0.5% (heavy), 4 mL ampul (spinal) (as hydrochloride) shall be erased from the list of the delisted preparations.  Therefore, bupivacaine injection 0.5% (heavy), 4 mL ampul (spinal) (as hydrochloride) is compensable.

All other issuances inconsistent with this circular are hereby repealed and modified accordingly.

Adopted: 15 Nov. 2004


(SGD.) DR. FRANCISCO T. DUQUE III
Secretary
President and CEO
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