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(NAR) VOL. 17 NO. 1 / JANUARY - MARCH 2006

[ PHILHEALTH CIRCULAR NO. 03, S. 2006, January 26, 2006 ]

NON-REIMBURSEMENT OF CLAIMS FOR PHILIPPINE NATIONAL DRUG FORMULARY (PNDF) DRUGS AND QUANTITATIVE BUFFY COAT ANALYSIS USED BEYOND THEIR ACCEPTABLE INDICATIONS



Pursuant to Section 37, Article 8 of Republic Act No. 7875, which states that the performance of medical procedures and the administration of drugs are appropriate, necessary and unquestionably consistent with acceptable standards of medical practice and ethics, the drug and laboratory procedure that were found inappropriate to their use shall not be reimbursed to wit:

    1. Human albumin solution. This is licensed for use for cases where restoration and maintenance of circulating blood volume is inappropriate, and for burns and hypoproteinemia. Its off-label use for neurosurgical conditions to decrease intracranial pressure is not recommended thus, shall not be compensated.

    2. Quantitative Buffy Coat Analysis (QBCA). This laboratory procedure is a classical hematocrit centrifuge that provides a hematocrit value, total WBC count, platelet count and a separation of the leukocyte population into granulocytes and nongranulocytes. It is a rapid means of performing screening complete blood count (CBC) but does not provide accurate results for all parameters of the CBC. The QBCA when used as tool for determining CBC shall not be compensated.

This circular shall take effect for all claims with admission dates starting March 1, 2006.

All other provisions consistent herewith shall remain in full force and effect.

Adopted: 26 Jan. 2006

(SGD.) LORNA O. FAJARDO, CESO III
Officer-In-Charge
Office of the President and CEO

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