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(NAR) VOL. 14 NOS. 3-4 / OCTOBER - DECEMBER 2003

[ PHIC PHILHEALTH CIRCULAR NO. 026, s. 2000, August 28, 2000 ]

EFFECTIVITY OF IMPLEMENTATION AND/OR COMPENSABILITY OF CLAIMS FOR DRUGS/MEDICINES DELISTED FROM/ADDED TO PNDF



Section 37of R.A. 7875 provides, among others, that payment for drugs shall be made only for those included in the Philippine National Drug Formulary (PNDF) unless explicit exception is granted by the Corporation.

In relation thereto, drugs and medicines are delisted and/or added to the list of reimbursable drugs/medicines (PNDF) from time to time. To settle the issue on the effectivity of its implementation and/or compensability of claim/s for drugs/medicines, the following rules are hereby adapted:

  1. The effectivity of the 5th Edition of the PNDF shall be July 24, 2000.

  2. Drugs and medicines not listed in the PNDF but are approved by the Bureau of Food and Drugs (BFAD) and the Health Technology Assessment (HTA) Committee shall be compensable based on PhilHealth Positive List.

  3. Claim/s for drugs/medicines that are delisted from the PNDF and were administered during the confinement period when the list takes effect shall remain compensable for that confinement.

Example: Confinement period was from January 7-15, 2000. Medicines were delisted January 10, 2000.

Therefore, claim for delisted drugs/medicines administered during the confinement period January 7-15, 2000 is COMPENSABLE.

For strict compliance.

Adopted: 28 Aug. 2000

(SGD.) ENRIQUE M. ZALAMEA
President and CEO

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