PhilHealth Increases Dialysis Coverage to PHP 1 Million Per Year

The Philippine Health Insurance Corporation (PhilHealth) has raised the annual dialysis coverage for patients with chronic kidney disease stage 5 (CKD5) to almost PHP 1 million. The move is part of the agency’s efforts to reduce out-of-pocket expenses for dialysis patients and improve access to life-saving treatments. The hemodialysis package increased from PHP 4,000 to PHP 6,350 per session, effective October 9, 2024, under PhilHealth Circular No. 2024-0023.

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PhilHealth’s leadership emphasized that this adjustment aligns with the Universal Health Care Law, aimed at providing better financial protection for members. This latest increase builds on the earlier rate hike in July and is intended to eliminate co-payments for patients availing of the minimum required services during dialysis sessions.

Dialysis Package Increase and Coverage Details

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Under the new circular, PhilHealth members and their qualified dependents with CKD5 can now claim up to PHP 990,600 in dialysis benefits per year. This significant increase in the per-session rate ensures that patients receive comprehensive care at accredited dialysis centers, including both public and private facilities. The essential services covered in this package include anti-coagulation medications, drugs for managing anemia, and various laboratory tests. The package also covers critical supplies like dialyzers, hemodialysis solutions, and administrative fees for the use of dialysis machines and other utilities.

The increase follows feedback from patients who, despite the PHP 4,000 coverage provided since July, still faced out-of-pocket costs. PhilHealth President and CEO Emmanuel Ledesma noted that the ultimate goal is to remove co-payments for the basic dialysis package, ensuring that no patient pays extra for essential services. The cooperation of nephrologists and dialysis centers is credited for helping achieve this no copayment goal.

Expanded Benefits for CKD5 Patients

Patients who require additional services beyond the minimum package may still be subject to co-payments, though these are regulated. A cap of PHP 450 has been set for professional fees if additional medical interventions or telemedicine consultations are needed during dialysis. Furthermore, if any co-payments are required, dialysis centers are mandated to provide a clear explanation to the patient to maintain transparency.

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The dialysis package increase provides much-needed relief for Filipino CKD5 patients, especially those undergoing frequent dialysis sessions. With the updated benefit structure, the cost of up to 156 dialysis sessions annually can be fully covered, reducing financial burdens and encouraging more patients to seek necessary medical treatment without fear of high expenses.

Patient Reactions and Future Steps

The news of increased coverage has been warmly received by dialysis patients across the country. Roseanne Lappay, a dialysis patient from Pateros, expressed her gratitude, noting that the increase has brought renewed hope to individuals relying on dialysis to manage their kidney disease. This financial protection is expected to make a meaningful difference in the lives of patients and their families.

PhilHealth leadership reiterated their commitment to fulfilling promises made to members. Ledesma reassured the public that the agency is committed to improving its services and urged Filipinos not to hesitate in seeking medical treatment, as PhilHealth continues to provide substantial coverage for vital health services.

Professional and Administrative Considerations

Apart from the increased session rate, the new package includes specific guidelines on the essential services that dialysis facilities must provide. These include both medications and equipment required for a standard dialysis session, ensuring that all accredited facilities follow a uniform standard of care. In cases where a patient opts for premium services outside the standard coverage, co-payments will be applied, but these must be justified and explained by the facility.

The cooperation between healthcare providers and PhilHealth is pivotal to the success of this initiative. With the increased financial support and regulated co-payment systems, PhilHealth aims to make dialysis treatment more accessible and affordable for its members, helping CKD5 patients manage their condition with less financial strain.

Video: PhilHealth Raises Dialysis Coverage to 1-M  

Watch this video from UNTV news and Rescue and learn more about the increase in PhilHealth dialysis coverage to PHP 1 million annually along with the impact of this policy change on CKD5 patients and the process of availing the updated dialysis benefits.

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