PhilHealth to expand outpatient care program by end of year

The Philippine Health Insurance Corp. (PhilHealth) is planning a significant expansion of its healthcare benefits programme, aiming to make crucial outpatient medications more accessible to its members across the nation. The expansion of the Guaranteed and Accessible Medications for Outpatient Treatment (Gamot) programme is slated for completion before the end of 2026.

Expanding Access to Essential Medicines

PhilHealth spokesman Dr. Israel Pargas announced the expansion plan on Thursday. The Gamot programme currently provides members with up to P20,000 annually to cover the cost of outpatient medicines. This benefit focuses on 75 essential drugs used in the treatment of chronic conditions like hypertension, diabetes, and asthma, with the goal of lessening the financial burden on patients managing long-term illnesses.

Did You Know? The Gamot programme covers 75 essential drugs for chronic conditions, aiming to reduce out-of-pocket expenses for patients.

To utilize the Gamot benefit, members or their dependents must first consult with a physician at an accredited Yaman ng Kalusugan programme (Yakap) clinic. The Yakap physician will then issue a prescription, which the patient can present, along with required identification, at an accredited Gamot provider to receive the necessary medications. Follow-up visits with the Yakap physician are a requirement for continued access, ensuring ongoing monitoring of the patient’s health.

programme Rollout and Additional Benefits

The Gamot programme was initially launched in Manila in 2025 and has since been extended to other cities. On February 17th, PhilHealth launched the programme in Cebu, collaborating with the Cebu provincial government. The launch event included demonstrations at three Gamot-ready providers: Isidro Kintanar Memorial Hospital, Clinica Prime (with partner pharmacy La Nueva), and the University of Cebu Medical Center.

Expert Insight: Expanding access to essential medications and preventative screenings represents a proactive approach to healthcare, potentially reducing the long-term strain on the healthcare system by addressing chronic conditions early and improving overall public health.

Beyond the Gamot programme, PhilHealth has also introduced free cancer screening tests under the Yakap programme. These screenings include mammography and breast ultrasound for breast cancer, alpha-fetoprotein tests for liver cancer, low-dose chest CT scans for lung cancer, and colonoscopies for colorectal cancer. PhilHealth is currently evaluating additional benefits that could be incorporated into the Yakap programme.

Frequently Asked Questions

How much money is available through the Gamot programme annually?

Members can receive up to P20,000 worth of free outpatient medicines each year through the Gamot programme.

What is required to access the Gamot programme?

Members or dependents must consult with a physician at an accredited Yaman ng Kalusugan programme (Yakap) clinic, obtain a prescription, and present it along with identification at an accredited Gamot provider.

Where has the Gamot programme been launched so far?

The Gamot programme was initially launched in Manila in 2025 and has since been launched in Cebu, in partnership with the Cebu provincial government.

How might the expansion of these programs impact healthcare access for Filipinos in the coming years?