Major Win for Dialysis Patients:
In line with President Ferdinand R. Marcos, Jr.’s assurance of continuous expansion in healthcare benefits despite zero subsidy, the Philippine Health Insurance Corporation (PhilHealth) has substantially enhanced its Z Benefit Package for Peritoneal Dialysis, this time with separate packages for adult and pediatric patients, effective January 1, 2025.
According to the National Kidney and Transplant Institute, peritoneal dialysis (PD) is a form of renal replacement therapy (RRT) where the patient’s own peritoneal membrane or lining of abdominal organs and body surfaces within the abdominal cavity is used as artificial kidney.
The enhanced PD package covers different modalities based on age. For adults, PhilHealth pays for Continuous Ambulatory Peritoneal Dialysis (CAPD), and both CAPD and Automated Peritoneal Dialysis (APD) for younger patients.
“We want to encourage the availment of peritoneal dialysis as a first line modality treatment for patients with Chronic Kidney Disease Stage 5”, said PhilHealth President and CEO Emmanuel R. Ledesma, Jr. “PhilHealth wants to push this as an option apart from hemodialysis, not just to give autonomy and flexibility to our members in choosing the treatment modality, but also to promote quality of life and mobility of patients”, he added.
For adult patients, coverage could either be P389,640 or P510,140, depending on the PD solutions a patient needs per day. The package used to be at P270K per year.
Meanwhile, benefits for pediatric patients under CAPD ranges from P510K to P765,210, while coverage for APD ranges from P763K to P1.2 million. PhilHealth also pays for exit site infection and peritonitis prevention care as well as ancillary services which include catheter insertion, outpatient treatment of PD-related peritonitis and laboratory, diagnostic tests, and drugs and medicines for both adult and pediatric cases.
According to PhilHealth Circular No. 2024- 0036, patients with Chronic Kidney Disease Stage 5 who will avail of this type of RRT shall first be registered in the PhilHealth Dialysis Database and shall comply with existing membership eligibility guidelines. Patients shall also adhere to the treatment plan, including follow-up visits. They are strictly prohibited from sharing, selling or distributing PD solutions provided them.
Furthermore, the contracted providers or health facilities are prohibited from charging co-payments for essential health services. However, co-payments may be charged for services and amenities that are not included in the list of essential health services covered by the package. Providers are likewise advised to fully explain to the patients whatever co-payment that will still be charged to them.
The enhanced PD Z Benefits are available at any of the 51 contracted PD providers nationwide, the list of which can be viewed at www.philhealth.gov.ph. Members may also seek further information and assistance by calling the following 24/7 touch points: (02) 866-225-88 or at mobile numbers 0998-857-2957, 0968-865- 4670, 0917-1275987 or 0917-1109812.
