PhilHealth dialysis order ‘rushed’ ahead of SoNA

An official from the Philippine Society of Nephrology (PSN) on Friday disclosed that the Philippine Health Insurance Corporation (PhilHealth) allegedly “rushed” a circular deemed to benefit patients with chronic kidney diseases, which will later be included in President Ferdinand Marcos Jr.’s third State of the Nation Address (SoNA), even if it is a burden to the dialysis centers and nephrologists that officiates hemodialysis (HD) treatment procedure to patients.

In an exclusive interview, PSN president Dr. Pelagio Esmaquel revealed that PhilHealth convened them — along with officials of Dialysis Coalition of the Philippines Inc. (DCPI) — last 3 July to collate inputs and ideas for the PhilHealth Circular 2024-0014 or the Institutionalization of 156 HD Sessions and Coverage Expansion.

“We were there and we gave inputs. However, our suggestions were not considered and included in crafting the circular. Parang formality lang. It is said that they are rushing the work for it to be included in the SoNA. That’s the order,” Esmaquel said.

However, the PSN official said that he was not privy to whom the order came from.

The PhilHealth circular was allegedly signed by PhilHealth president and CEO Emmanuel Ledesma last 28 June, or five days before the group of Esmaquel and officials of DCPI were summoned for the purported consultation.

“During our meeting, they (PhilHealth) admitted that they hastened the release of the circular and it was not reviewed or studied much,” Esmaquel said.

The circular aims to establish the rules for availing the adjusted rates of the 156 HD sessions benefits package, which shall apply to beneficiaries diagnosed with chronic kidney disease stage 5 registered in the PhilHealth Dialysis Database.

In a separate interview on Thursday, the DCPI expressed concerns about the circular, which sets the reimbursement rate for each session at P4,000 and prohibits additional charges to patients under the “No Balance Billing” system.

Esmaquel also hit the move of PhilHealth to include the medications for HD, namely Erythropoietin, Iron Sucrose and Enoxaparin, which can eventually be interpreted by patients that should be used for their treatment.

“That should not be the minimum standard. In medicine, the minimum standard is safety, and efficacy, among others. As the medicines were included in the package, they will be requested from us by the patients which can be dangerous. These medicines are only given to patients on a case-to-case basis,” Esmaquel said.