Implementing Guidelines on the Strict Enforcement of R.A. 6675

September 8, 1999

PHILHEALTH MEMORANDUM CIRCULAR NO. 09-99

To carry out the provisions of PhilHealth Board Resolution No. 265 s. 1999 dated July 15, 1999, these implementing guidelines are hereby adopted:

SECTION 1. Statement of Policy

1a) All accredited professionals and institutions, government and private, shall use generic terminology in all their hospital charts and prescriptions;

1b) The Philippine National Drug Formulary latest edition, shall be used as reference of all pharmaceutical for purposes of claims reimbursements;

1c) All Tertiary and Secondary Hospitals and Ambulatory Surgical Clinics shall establish a therapeutic committee, establishments of which shall be an absolute requirement in the accreditation of institutional health care providers.

1d) Development of prescribing guidelines, diagnostic/therapeutic reference pricing, and corporate information and education campaign to promote technical efficiency, pharmaceutical affordability and rational use of drugs among providers.

SECTION 2. Implementing Agencies, Offices

2a) Accreditation and Quality Assurance Department thru the Health Technology Assessment Committee (HTAC) shall:

2a-1. serve as the clearing house of issues/request with regard to the inclusion of drugs not in the PNDF subject to the approval of the PHIC Board for the purpose of reimbursing/payment of claims.

2a-2. recommend to the PHIC Board thru the President and CEO, programs and policies designed to meet the needs of health providers for current knowledge on matters related to drug use.

2a-3. assist the Corporate Communication Office of the Corporation in developing educational and behavioral intervention in drug use among PHIC members, beneficiaries, and accredited health care providers.

2a-4. conduct study on drug prices and provide up-to-date information on the activity.

2b) Regional Health Insurance Offices:

2b-1. The Regional Health Insurance Managers — shall carry out and supervise the implementation of the use of PNDF, reimbursement of drugs in generic terminology and in PNDF, and promotion of good prescribing among the accredited health providers.

2b-2. Head of Medical Evaluation Division — shall directly supervise the medical evaluators and shall ensure the proper application of this guideline in the reimbursement/payment of claims.

2b-3. The Medical Evaluator shall:

1. analyze and decide on the merit of the claims submitted by health care providers;

2. be responsible in disallowing drugs and medicines not written in its generic terminology or drugs not found in the PNDF subject to 2a-1.

2b-4. Accreditation and Quality Assurance Officer — shall monitor the appropriate implementation of this guideline and compliance of the accredited health care providers.

SECTION 3. Therapeutic Committee

The Therapeutic Committee (TC) shall be the highest professional body of the hospital in drug-related issues and shall exert genuine influence in the drug use in the hospital.

Composition and functions of the TC indicated in DOH A.O. 51 s. 1988 shall be enforced and be used by the Accreditation and Quality Assurance Department as one of the basis in monitoring the performance of institutional health care providers.

SECTION 4. Prescribing and Ordering

All prescription and orders for drugs and medicines in institutional health care providers shall be in generic terminology. DOH A.O. 62 s. 1989 "Rules and Regulations to implement prescribing requirements under the Generic Act of 1988" shall be used as the guide in evaluating the appropriateness of prescription and written orders in the patient chart.

Drugs and medicines that are de-listed by the Bureau of Food and Drugs and the Department of Health because of failure to satisfy the eligibility standards/registrations criteria and cause adverse drug reaction shall also be used as reference guide in parallel with the prescribed edition of PNDF.

SECTION 5. Dispensing and Administering

Allied medical and dispensing staff in hospital and other institutional health care providers shall use generic terminology in patient charts as well as in the accomplishment of Part 3 of PHIC Form 2 for reimbursement.

SECTION 6. Information and Education

The Corporate Communications Office of the PHIC shall ensure together with the HTA Committee the development of information and education campaign particularly the member/patient education. CORCOMM shall ensure education of the general public to increase public awareness on appropriate drug use and discourage drug misuse/abuse.

SECTION 7. Violation

Failure to observe these guidelines shall be regarded as a violation of Sec. 38 of R.A. 7875, E.O. 49, R.A. 6675 and breach of warranties of accreditation.

SECTION 8. Sanction

The Corporation shall deny payment of drugs prescribed in violation of this circular without prejudice to other sanctions and penalties as provided for in the rules.

SECTION 9. Effectivity

This Circular shall take effect thirty (30) days after its publication.

Quezon City, Philippines, September 8, 1999.

 

(SGD.) ENRIQUE M. ZALAMEAPresident and CEO