Breast cancer benefit now up to Php 1.4 million – PhilHealth

Effective March 30, 2024, PhilHealth’s Z Benefit package for breast cancer is now up to P1.4 million, a 1,400% increase from the previous package of 100,000.

PhilHealth Circular 2024-0007, which was published recently, stated that the enhanced Z Benefit Package now covers Stages 0 to 4 of breast cancer and even expanded the eligibility qualifications of members who can avail, even covering patients already undergoing treatment for the said illness.

“This significant leap in the Z Benefits Package for breast cancer is proof that PhilHealth is committed to delivering our mandate, to provide responsive benefits to our Kababayans and we will continue implementing benefits that will improve the financial coverage under our thrust Pinalawak at Bagong Benepisyo para sa Mamamayang Filipino”, said PhilHealth President and Chief Executive Officer Emmanuel R. Ledesma Jr.

He added that “this package provides a ‘holistic approach’ to breast cancer treatment because it covers diagnostic tests, breast cancer management up to surveillance or assessment for early signs of relapse after the surgery”.

Based on the guidelines, the mandatory services have different package rates depending on the doctor’s recommendation which is based on the patient’s requirements.  Diagnostic tests and prognostication range from Php 1,000 to Php 10,000.00; surgical procedures from partial mastectomy to modified radical mastectomy range from Php 30,000 – Php 140,000.00; hormonotherapy coverage is Php 2,700 or Php 18,000 while cytotoxic chemotherapy shall be paid from Php 43,000 to Php 185,010.  The bulk of the package goes to targeted therapy amounting to more than Php 1 million coverage, which translates to Php 333,336 for 18 maximum cycles.  The surveillance, which is divided into basic and specific services, ranges from Php 5,000 and Php 9,000 respectively.

To avail of the enhanced Z Benefit Package for breast cancer, members or their qualified dependents are advised to contact the Z Benefits Coordinator of any of the current 21 contracted health facilities for them to be guided on the availment procedures from pre-authorization procedures up to cost-sharing aspect of the treatment, if there is any.

The Z Benefits Coordinator is also responsible to coordinate with PhilHealth on matters pertinent to the availment of the patient and ensure the completeness and accuracy of all required documents for pre-authorization and claims application for reimbursement.

Further, PhilHealth stressed that no co-payment shall be charged for services rendered on patients admitted in basic or ward-type accommodation.

Contracted health facilities are those capable of rendering specialized care that enter into a contract with PhilHealth for the provision of specialized care for the Z Benefits.

The PhilHealth Chief further said, “We are hoping that this will have a ripple effect on the healthcare system of the country.”  He further encouraged qualified health facilities to be contracted to provide this benefit so it would be more accessible to patients needing treatment.”