PhilHealth to make anti-TB medicines more accessible

MANILA, Philippines — The Philippine Health Insurance Corporation (PhilHealth) will expand access to selected first-line anti-tuberculosis (TB) medicines through its Guaranteed and Accessible Medications for Outpatient Treatment (GAMOT) program starting November 1, 2026.

Under PhilHealth Circular No. 2026-0018, eligible members and dependents diagnosed with confirmed drug-susceptible tuberculosis (DS-TB) may obtain covered medicines from PhilHealth-accredited GAMOT facilities using prescriptions issued by Yaman ng Kalusugan (YAKAP) physicians.

PhilHealth, in a statement, said the expanded benefit aims to bridge gaps in TB treatment by linking primary care consultations with access to prescribed medicines.

The initiative supports the government’s Unified National Agenda for Health, particularly its goal of establishing a functional primary care system

Importantly, the covered anti-TB medicines will not be deducted from the member’s ?20,000 annual GAMOT benefit limit, allowing the allocation to remain available for other covered outpatient medicines.

Eligible patients may receive up to a one-month supply of first-line anti-TB medicines per transaction. GAMOT facilities are required to dispense the complete prescribed quantity within two days from the issuance of the GAMOT prescription.

Patients must claim their medicines within the prescribed period. Those who fail to do so may still obtain the medicines by paying out of pocket or securing an updated prescription.

YAKAP-accredited physicians must issue prescriptions through the GAMOT Application and follow the treatment protocols of the Department of Health-National Tuberculosis Control Program.

To ensure availability, accredited GAMOT facilities must submit an updated Certification of Availability to their respective PhilHealth Regional Office before dispensing anti-TB medicines.

PhilHealth will directly reimburse participating GAMOT facilities based on the fixed fees provided under the circular.

The expanded GAMOT benefit will complement, rather than replace, the existing Outpatient TB-DOTS Package, which remains PhilHealth’s primary benefit for comprehensive outpatient TB care.

TB-DOTS facilities will continue providing comprehensive care and dispensing anti-TB medicines when they have sufficient supplies.

However, if first-line anti-TB medicines are dispensed through a GAMOT facility instead of the TB-DOTS facility, a 50 percent automatic deduction will be applied to the TB-DOTS package claim for each treatment phase.

PhilHealth advised members to consult their YAKAP-authorized physician or TB-DOTS provider to determine the appropriate treatment arrangement and how to access the expanded benefit.

Through YAKAP and complementary benefits such as GAMOT, PhilHealth said it aims to make essential medicines more accessible, support continuity of TB treatment, and reduce financial barriers to healthcare. — /MRM (FREEMAN)