PhilHealth increases yearly dialysis coverage to 156 sessions

The Philippine Health Insurance Corporation (PhilHealth) announced that its coverage for hemodialysis has been expanded from 90 to 156 sessions starting this year as provided for in PhilHealth Circular 2023-0009 entitled “Institutionalization of 156 hemodialysis sessions” which takes effect today, June 22, 2023.

PhilHealth members and their qualified dependents diagnosed with chronic kidney disease stage 5 (CKD5) needing hemodialysis as prescribed by their nephrologists may avail themselves of this benefit package.

The patient should also be registered in the PhilHealth Dialysis Database prior to availment.

The state-run health insurer explained that the total of 156 sessions is in accordance to the current standards for adequate hemodialysis of three sessions per week for 52 weeks which is equivalent to one year.

With this benefit expansion, CKD5 patients on hemodialysis can avail of as much as P405,600 per year at P2,600 per session.

“We are confident that this will adequately support our Kababayans who need this life-saving treatment,” PhilHealth President and CEO Emmanuel R. Ledesma, Jr. said.

“Ang pagpapalawig ng benepisyo para sa hemodialysis ay patunay na ang PhilHealth ay nakikinig sa panawagan ng ating mga miyembro. Patuloy ang aming pag-aaral na mapabuti ang mga benepisyo ng PhilHealth upang mas mabigyan pa ng sapat na financial risk protection ang mga Filipino,” Ledesma added.

However, PhilHealth strongly advocates for peritoneal dialysis (PD) first, as it encourages accredited healthcare providers to recommend PD as the initial line of treatment for CKD5 patients.

On the other hand, kidney transplantation remains the gold standard treatment for patients with kidney failure.

The state Agency said it is set to increase financial coverage for its peritoneal dialysis and kidney transplantation packages in the next two years. As such, all health facilities should register their newly diagnosed CKD Stage 5 patients needing renal replacement therapy in the PhilHealth Dialysis Database.

Ledesma also emphasized that the expansion in hemodialysis coverage as well as its institutionalization is made possible with the help of the Philippine Amusement and Gaming Corporation (PAGCOR) and Philippine Charity Sweepstakes Office (PCSO). 

“Sa tulong ng PAGCOR at PCSO ay mabilis nating maipatutupad ang Universal Health Care Law.  Ang pagpapalawak ng benepisyo ng PhilHealth ay bilang pagtugon din sa  prayoridad ng ating Pangulong Ferdinand R. Marcos Jr. na mabawasan ang out-of-pocket expenses sa kalusugan ng mga Filipino na naaayon sa layunin ng ating pamahalaan na Matatag, Maginhawa at Panatag na Buhay para sa Filipino sa 2040,” he said.

A total of P21 billion from the said partner agencies have already been approved for transfer to PhilHealth under the 2023 General Appropriations Act.