Updated October 19, 2026. The Philippine Health Insurance Corporation (PhilHealth) is adding selected first-line anti-tuberculosis (TB) medicines to its Guaranteed and Accessible Medications for Outpatient Treatment (GAMOT) program. Under PhilHealth Circular No. 2026-0018, published on October 17, 2026, eligible members and dependents with confirmed drug-susceptible TB can get covered anti-TB medicines from PhilHealth-accredited GAMOT facilities using a prescription from a YAKAP physician, starting November 1, 2026.
What does PhilHealth Circular 2026-0018 do?
The circular, titled Guidelines on Expanding Access to Outpatient First-line Anti-TB Drugs through PhilHealth GAMOT, adds the medicine component of drug-susceptible TB (DS-TB) treatment to PhilHealth GAMOT, the state insurer’s outpatient drug benefit. Its stated goals are to:
- Expand the GAMOT List with first-line anti-TB drugs for DS-TB
- Ensure continuous and wider access to anti-TB medicines by using accredited GAMOT facilities for dispensing
- Set the payment adjustments and reimbursement rules for TB-DOTS facilities and GAMOT facilities
When does it take effect?
The circular takes effect 15 days after its publication in a newspaper of general circulation. It was published on October 17, 2026, and PhilHealth said the expanded access starts on November 1, 2026.
Who is eligible?
The benefit covers eligible PhilHealth members and their dependents who have been diagnosed with confirmed drug-susceptible tuberculosis (DS-TB). Only medicines prescribed by authorized physicians through the GAMOT Application (GAMOT App) are covered.
Which anti-TB medicines are covered?
The updated GAMOT List (Annex A.1 of the circular) adds these first-line anti-TB drugs:
| Drug | Indication (per the circular) |
|---|---|
| Isoniazid + Rifampicin + Pyrazinamide + Ethambutol | Treatment of tuberculosis |
| Isoniazid + Rifampicin | Treatment of tuberculosis |
| Isoniazid + Rifampicin + Pyrazinamide | Treatment of tuberculosis |
| Ethambutol | Treatment of tuberculosis in combination with isoniazid, rifampicin and pyrazinamide |
Each covered drug has a fixed fee in the circular’s GAMOT Fixed Fee Schedule (Annex A.2), and dosing and treatment duration follow the Department of Health National TB Control Program (DOH-NTP) Manual of Procedures, 6th edition.
How to get anti-TB medicines through GAMOT
- Consult your YAKAP physician or TB-DOTS provider. PhilHealth encourages members to ask their YAKAP Authorized Physician or TB-DOTS provider about the right treatment arrangement and how to access the benefit.
- Get a GAMOT prescription. The YAKAP-accredited physician issues the prescription through the GAMOT App, following DOH-NTP treatment protocols. Up to one month’s supply may be prescribed per transaction.
- Claim your medicines within two days. The accredited GAMOT facility must dispense the full prescribed quantity within two (2) days from the date the GAMOT prescription is issued.
- Refill on time. Refill prescriptions may be issued and dispensed starting 14 days after the previous prescription date.
If you miss the two-day claiming period, the pharmacy can still dispense the medicines, but you will have to pay out of pocket. Your doctor can update the GAMOT prescription if the medicines are still medically necessary.
Will it reduce my PHP 20,000 GAMOT benefit?
No. Anti-TB medicines dispensed under GAMOT are not deducted from the member’s Annual Benefit Limit. PhilHealth said this preserves the PHP 20,000 annual GAMOT benefit limit for other covered outpatient medicines.
What happens to the TB-DOTS package?
The expanded benefit complements, not replaces, the Outpatient TB-DOTS Package, which remains PhilHealth’s primary benefit for comprehensive outpatient TB care. TB-DOTS facilities with enough supply of first-line anti-TB drugs will keep providing comprehensive care and dispensing medicines.
When the anti-TB drugs for a treatment phase are dispensed by a GAMOT facility instead of the TB-DOTS facility, PhilHealth automatically deducts 50% from the TB-DOTS package claim for that phase. The full set of medicines for each phase must come from only one provider, either the TB-DOTS facility or a GAMOT facility.
| Treatment phase | Package code | Case rate | Adjusted facility claim |
|---|---|---|---|
| Intensive phase | 89221 | PHP 4,875.00 | PHP 2,437.50 |
| Continuation phase | 89222 | PHP 2,925.00 | PHP 1,462.50 |
What pharmacies need to do
- Before dispensing anti-TB drugs, accredited GAMOT facilities must submit an updated Certification of Availability of GAMOT, signed by the facility head, to their PhilHealth Regional Office.
- PhilHealth reimburses participating GAMOT facilities directly based on the fixed fees in the circular.
PhilHealth said the policy supports comprehensive primary care under the Yaman ng Kalusugan Program (YAKAP) by linking primary care consultations with access to prescribed medicines.
Sources
PhilHealth Circular No. 2026-0018 (PDF); PhilHealth 2026 circulars page; Philippine News Agency: PhilHealth expands access to anti-TB medicines through GAMOT, October 19, 2026.
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