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PhilHealth benefit package for people with HIV under review

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VERA Files | 01 December 2015

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PhilHealth HIV - ARV Bottles

ARV Bottles

As the country commemorates World AIDS Day today (December 1), the Philippine Health Insurance Corp. (PhilHealth) is set to begin a formal review of its benefit package for people living with HIV (human immunodeficiency virus), or PLHIVs.

“We are currently reviewing the Outpatient HIV/AIDS Treatment (OHAT) Package, the implementation of it in treatment hubs, and the current rates, and if patients have questions, we can discuss it with them.  PhilHealth is going to conduct a formal review of benefits, this year up to next year, to address these issues,” Dr. Mary Antoinette Remonte, Medical Specialist II and Millennium Development Goals Benefit Products Team Head of PhilHealth, said.

PLHIVs in the country, who are members of PhilHealth, are entitled to several benefits under the OHAT Package. Every year, a member is entitled to P30,000, or P7,500 every quarter, worth of treatment, care and support (TCS) services from his chosen PhilHealth accredited treatment hub.

Also included in the OHAT Package are the following: drugs and medicines; laboratory examinations based on the specific treatment guideline, including Cluster of Differentiation 4 (CD4) level determination test, viral load (if warranted), test for monitoring antiretroviral (ARV) drug toxicity; and professional fees of providers.

Hospitalization coverage from PhilHealth ranges from P11,000-20,000, depending on the case. Any amount that will exceed the allotted budget will be charged to the patient.

DOH National Epidemiology Center

DOH National Epidemiology Center

However, PhilHealth has received  reports from several PLHIVs that the TCS services they get from their treatment hubs are different compared to other TCS providers.

“It has come to our attention that some treatment hubs charge for some laboratory tests, even after the release of the OHAT Package circular. Also, according to the guidelines set by the DOH (Department of Health), viral load testing is also covered by the OHAT Package,” Dr. Remonte said.

In the case of Paolo (not his real name), a person living with HIV  (PLHIV) from Manila who is receiving HIV TCS at San Lazaro Hospital, he was made to pay for the viral load test even if he is a PhilHealth member.

Sadly, if you are a PHLIV who had been charged for a particular TCS service, that is supposedly covered by the OHAT Package, “you cannot be reimbursed for what you spent, because the reimbursement goes directly to the facility. This is why it is important for a facility to properly maximize the reimbursement claims so they can help the patients,” Dr. Remonte added.

But the practice in other treatment hubs, like in the Research Institute for Tropical Medicine (RITM), is different. PLHIVs are able to receive free baseline laboratory tests and CD4 count.

“The OHAT Package does not cover baseline tests yet, but due to good financial management, we can provide them for free to new patients. And once they start their treatment, they would be eligible for OHAT,” Dr. Rosanna Ditangco, research chief head at RITM-ARG, explained.

For patients who are already starting their antiretroviral therapy, “we provide free CD4 and CBC tests. Yearly, during their anniversary, we provide free CD4, CBC, blood chemistry – depending on what ARV they are taking, and viral load. And if the doctor suspects treatment failure, a free viral load test will be done anytime plus HIV drug resistance testing,” Dr. Ditangco added.

That has been the system of RITM ever since PhilHealth released their OHAT Package circular.

“The HIV treatment regimen is standard for all treatment hubs, but the cost of laboratories are not the same. The practice is also different on how they utilize the PhilHealth reimbursement and this is because of administrative problems in the treatment hubs,” Dr. Remonte explained.

She also reminded PLHIVs to check if their treatment hubs were filing claims and if they find out that there were lapses, they could write a complaint, anonymously if they are worried about confidentiality.

For PLHIVs who want to avail of the benefits of the OHAT Package, they should be PhilHealth members with three to six months contributions; submit a waiver allowing PhilHealth to look in to their records; and provide a copy of their HIV confirmatory result and treatment regimen.

There are currently 22 accredited hospitals all over the country that are designated treatment hubs for PLHIVs. There are also several satellite clinics that provide TCS services for HIV management.

Like other agencies and institutions, PhilHealth is increasing its efforts to help manage the detrimental effects of HIV.

The Philippines is one of the countries where the prevalence of HIV has been increasing.

On the other hand, statistics from other countries show that HIV is already decreasing, or at zero growth.

As of August this year, there were already more than 5,000 reported HIV cases in the Philippines, according to the DOH. This number is 17% higher compared to the same period last year.

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(VERA Files is put out by veteran journalists taking a deeper look at current issues. Vera is Latin for “true.”

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PhilHealth clarifies OHAT coverage

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Outrage Magazine | 29 August 2015

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This is a continuing story on the disparities in the services received by PLHIVs in different hubs in the Philippines, even if they are required to pay the same amount by PhilHealth.

As the Red Ribbon Project eyes to help the country get to zero (i.e. zero new HIV infection, zero AIDS-related death, and zero HIV-related discrimination), its beauty queens – Binibining ARV-Universe, Bb. ARV-World and Bb. ARV-International; joined by Miss ARG 2012 – gives the “beauty with a purpose” tagline flesh, this time by reaching out to Filipino PLHIVs in RITM.
“That there’s still something to live for,” is the goal of the outreach, said Pozzie Pinoy, who helms Red Ribbon Project – seconded by Bb. ARV-Universe, who said in the vernacular that “if we can – even for a while – shed some hope, that’s good and well.”

In the Philippines, the treatment, care and support received by most people living with HIV (PLHIVs) are covered by the Philippine Health Insurance Corporation’s (PhilHealth) Outpatient HIV/AIDS Treatment (OHAT) Package. Specifically, to those who are enrolled in PhilHealth, P30,000 is allocated per PLHIV per year, or P7,500 every quarter.

But – as stated in a previous report by Outrage Magazine – PLHIVs from different treatment hubs in the country experience different and at times confusing disparities in the services that they receive, even if they pay the same PhilHealth premium/amount of approximately P2,400 per year.

READING THROUGH

After the release of PhilHealth’s OHAT Package circular in 2010, DOH published Administrative Order No. 2010-0036 – The Aquino Health Agenda: Achieving Universal Health Care for All Filipinos – in December 2010, signed by then Health Secretary Enrique Ona.

It stated that “the Aquino Health Agenda (AHA) is a focused approach to health reform implementation in the context of HSRA (Health Sector Reform Agenda) and F1 (FOURmula One), that all Filipinos especially the poor receive the benefits of health reform.”

ARV is part of the “free” TCS services received by PLHIVs in the Philippines

Under that guideline is the attainment of health-related Millennium Development Goals (MDG), which include the reduction of HIV/AIDS prevalence.

The administrative order also mentioned that the “DOH shall develop guidelines and protocols to organize the community health team and service delivery network, implement a functional referral system, deliver health service packages, contract with private providers, implement clinical practice guidelines, generate, retain, and use hospital revenues, and establish hospital pricing system to maximize benefits from PhilHealth.”

In the 2010 OHAT Package circular, it stated that the “package shall be based on Department of Health (DOH) guidelines on anti-retroviral therapy among adults and adolescents with human immunodeficiency virus infection. All treatment hubs in accredited facilities are required to follow the guidelines set by the DOH.”

Meanwhile, the Guidelines on Antiretroviral Therapy (ART) among Adults and Adolescents with Human Immunodeficiency Virus (HIV) Infection – DOH Administrative Order No. 2009-0006 – released in January 2009 stated that as part of monitoring the response to ART treatment, “for patients with good compliance to ART, clinical response is recommended to be used together with CD4 count and viral load determination (whenever feasible) to detect treatment failure.”

And that “treatment hubs through its HIV AIDS Core Team (HACT) shall provide treatment and clinical monitoring of patients under ART.”

ACTUAL COVERAGE

In an interview with Outrage Magazine, PhilHealth’s Medical Specialist III and Millennium Development Goals Benefit Products Team Head Dr. Mary Antoinette Remonte said that “it has come to our attention that some treatment hubs charge for some laboratory tests, even after the release of the OHAT Package circular.”

The 2010 circular only specifically stated that “covered items under this benefit are drugs and medicines, laboratory examinations including Cluster Difference 4 (CD4) level determination test and test for monitoring of anti-retroviral drugs (ARV) toxicity and professional fees of providers.” As such, Remonte said that “some treatment hubs take what was written in the circular literally.”

Remonte, however, said that if a PLHIV needs “viral load, if it’s really needed, they can still charge it on the OHAT package. Any laboratory tests related to ART treatment, they can use the OHAT Package for it.” For Remonte, “even if viral load testing was not written in the first circular, it was already included in the coverage.”

The revised OHAT Package released last June already clearly states that “covered items under this benefit are drugs and medications, laboratory examinations based on the specific treatment guideline including Cluster of Differentiation 4 (CD4) level determination test, viral load (if warranted), and test for monitoring anti-retroviral (ARV) drugs toxicity and professional fees of providers.”

PhilHealth also monitors the disparities among the services offered by treatment hubs, particularly on whether they are putting into effect what were stated in the circulars that were released.

“We are currently reviewing the OHAT Package, the implementation of it in treatment hubs, and the current rates; and if they have questions, we can discuss it with them,” Remonte said.

PLHIVs, meanwhile, are encouraged to contact PhilHealth if they have concerns regarding their PhilHealth membership and coverage.

PROPER MANAGEMENT

According to Dr. Rosanna Ditangco, research chief atThe Research Institute for Tropical-AIDS Research Group (RITM-ARG), a treatment hub located in Alabang, management issues also come to play in the delivery of TCS services to PLHIVs.

For instance, while “the OHAT Package does not cover baseline tests yet”, at RITM-ARG, PLHIVs are able to receive free baseline laboratory tests, such as CBC, chest x-ray, PPD and blood chemistry (i.e. lipid profile, BUN, Creatinine, FBS), and CD4 count.

“Due to good financial management, we can provide these free baseline services to new patients; and once they start treatment, they would be eligible for the OHAT Package and RITM would be able to regain the initial investment,” said Ditangco.

Older PLHIVs, meanwhile, can already use their PhilHealth membership when availing different services and laboratory tests that are needed and related to their antiretroviral therapy (ART) treatment.

There are minimum number of tests that DOH mandates for treatment hubs to give to PLHIVs, so that hubs now offer different services aside from those mandated – and even if the amount they pay to PhilHealth remain the same

There are minimum number of tests that DOH mandates for treatment hubs to give to PLHIVs, so that hubs now offer different services aside from those mandated – and even if the amount they pay to PhilHealth remain the same

“Every six months, we provide free CD4 and CBC tests. And yearly, during their anniversary, we provide free CD4, CBC, blood chemistry – depending on what ARV they are taking, and viral load tests. If the doctor suspects treatment failure, a free viral load test will be done anytime, plus HIV drug resistance testing,” Ditangco said.

Ditangco added that “all of these are covered by OHAT. And this has been our system ever since PhilHealth released their first circular.”

RITM-ARG also receives “additional support” from the DOH, which the facility also uses when providing TCS services to PLHIVs.

“Our funding is mostly from our OHAT reimbursement, but every now and then, we receive funding from DOH and we use this to provide free viral load, CD4 or HIV drug resistance testing for other treatment hubs,” Ditangco said.

WAY FORWARD

Interviewed by Outrage Magazine in Davao City during the 1st HIV Summit in southern Philippines, DOH Usec. Vicente Y. Belizario Jr. said that the DOH mandates the “minimum package (to be provided by hubs to PLHIV).” However, “(health care) is decentralized to local government units, (and) there are LGUs that are more innovative.”

“The challenge is to ensure harmonization,” Belizario said, adding that this is what the DOH “will continue to push.”

For Dr. Jose Narciso Sescon of the AIDS Society of the Philippines, “one bright move towards ensuring standardization is that these are being discussed and taken on. This is a healthy step towards a more robust HIV package of services offered to clienteles… if and only if we are all open (government and private service providers) to take on to discuss and accept the real challenges faced by our program.”

“I believe all major government treatment hubs must agree on a standardized treatment package offered to their patients that can be availed under the PhilHealth OHAT Package. Having a national standard on HIV treatment services offered to Filipino PLHIVs will help avoid confusion and unnecessary inconvenience for patients,” said Kevin Kane Li of The AIDS Treatment Action Group (TATAG) Philippines.

Meanwhile, for Pozzie Pinoy of The Project Red Ribbon, “if your hubs are charging you for your laboratory tests in succeeding tests, you should start asking.”

Pozzie Pinoy likens the PhilHealth to having an insurance package, wherein “if you have an HMO, you have packages, and you must know what’s being spent on you.”  In the case of PhilHealth, “ask your hub what in your P30,000 is being spent. You paid for it, so it should be used for you. Learn to ask. Don’t turn a blind eye just to save face. This can be solved by asking.”– WITH INTERVIEWS BY MDCTAN

PhilHealth may be reached at (+63 2) 441 7444 or (+63 2) 441 7442, or email actioncenter@philhealth.gov.ph.

Outrage Magazine is one with the PLHIV community in demanding for a uniform implementation of TCS services, particularly as mandated by PhilHealth. 

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(Established in April 2007, Outrage Magazine remains the only publication exclusive for the lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual and allied community in the Philippines.)

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RITM: PLHIVs may not receive ARVs next week

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Outrage Magazine | 03 September 2014

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ARV

Time to panic?

Dr. Rosanna Ditangco, research chief at the Research Institute for Tropical Medicine-AIDS Research Group (RITM-ARG, one of the treatment hubs in the country), highlighted the dire situation faced by Filipino people living with HIV (PLHIV) after she reportedly said that the distribution of antiretroviral medicines (ARVs) may be stopped due to processing delays.

In a letter sent to the Department of Health (DOH) Secretary, Dr. Enrique Ona, dated September 2, HIV activist Pozzie Pinoy of the Red Ribbon Project, quoted Ditangco for saying that if the ARVs that are currently being held by the Bureau of Customs (BOC) will not be released by Friday, September 5, then “HIV treatment will totally stop all over the country.”

The Project Red Ribbon claimed receiving insider information that “BOC is requiring DOH to pay P5 million for the tax of the shipment (i.e. ARVs)”, and that “the said shipment has been in the storage of BOC since August of this year.”

DIRE SITUATION 

The number of HIV and AIDS cases in the Philippines already reached 19,915 as of July 2014, the National Epidemiology Center of the Department of Health (DOH) reported. And from January to July this year alone, the number of Filipinos living with HIV who are on antiretroviral therapy (ART) reached 7,172.

Obviously, the numbers are expected to rise, considering the continuing growing number of new cases reported by the DOH.

ON DEAF EARS

This issue was actually raised as early as February of this year, when PLHIVs started receiving limited supplies of ARVs from their treatment hubs. In a blog post by Pozzie Pinoy, Ditangco was quoted as saying that most Philippine HIV treatment hubs give out supplies for only either two weeks or one month, because of the delay in the delivery of meds to DOH.

After two weeks, Ditangco reported that the DOH will already deliver the ARV supplies to the respective treatment hubs.

Interestingly, according to Dr. Jose Gerard Belimac, head of DOH’s National AIDS/STI Prevention and Control Program, there is no delay in the procurement of ARVs, just as there is no “official pronouncement from the DOH to the treatment hubs to control [the distribution of ARVs] because of a delay in the procurement [of ARVs],” he said in an exclusive interview by Outrage Magazine.

Belimac also assured that “this is something we are trying to resolve, to ensure the continuity of treatment for PLHIV.”

What is not discussed is the delivery of ARVs differ from what PLHIVs use, with changes made to regimens of PLHIVs without medically sound reasons.  As a PLHIV whose medicines were changed last March stated, “the ARVs given [to] me were changed because there’s no stock of my usual ARVs. [The doctor said], no choice.”

ABNORMAL SITUATION?

Despite all these pronouncements about the availability of supplies, the fluctuating supply of ARVs continued in the next months. Different PLHIVs from different treatment hubs complained about the insufficient (from two weeks’ to one month’s supply, depending on the hub), ARVs given to them every time they get a refill.

Ditangco, in an interview by Outrage Magazine last April, said that “ang ARV supplies natin ay wala naman talagang problema. Nagkaroon lang tayo ng abnormal situation becausenagkaroon ng miscalculations in ordering (our ARV supplies do not have problems. We’re just having an abnormal situation because of miscalculations in ordering). There’s no need to cause unnecessary panic among PLHIVs.”

But panic is what is happening now.

During those months of notable ARV shortage, Project Red Ribbon actually purchased four boxes of Lamivudine and Tenofovir, a two-in-one mix of the two drugs.

“If there is no problem, why is it that we are buying from other countries to supplement the problems with the stocks? And we were able to release it from the (BOC) in just one week, as opposed to what other people are saying that it’s hard to release it from Customs. The PLHIV community is panicking for the past months now. The DOH has not been transparent with its programs when it comes to ARV medicines,” Pozzie Pinoy stressed.

Also, even as the DOH continues to deny that there is a problem with the supply of ARVs in the Philippines, one by one, treatment hubs started borrowing ARV supplies from other hubs that have “enough supply”.

Ditangco was in fact quoted by Pozzie Pinoy as saying that RITM-ARG, in the last two weeks, has been lending their ARV stocks to other HIV and AIDS treatment hubs in Metro Manila and in the provinces because of the shortage.

DELAY = DEATH

Last August 26, different LGBTQIA organizations from all over the Philippines – including Ladlad Caraga Inc., The AIDS Treatment Action Group Philippines (TATAG), REDx, Northern Mindanao Advocates, and The Well Philippines – wrote a letter to the BOC for it to provide a clearer picture on the following issues:

  1. What and how much were the duties and taxes imposed for the particular shipment?
  2. What is the basis of computation for duties and taxes levied against the imported ARVs?
  3. What is the cause of delay for the release of life saving ARVs to DOH?
  4. Is the agency taking any steps to expedite the release of ARVs to DOH?

To date, no response has been received, no matter the urgency of the issue.

Pozzie Pinoy is appealing to the DOH and the BOC to do something about this life and death situation.

“I am pleading and begging you, on behalf of the entire PLHIV community and the entire country, to please look into this matter immediately and find a quick solution to this problem. What we can do now is to call for the attention of your department, and of the BOC to take action before this gets out of hand,” he stated.

Outrage Magazine is one with the PLHIV community in demanding that the Department of Health should look into this matter as soon as possible and address this issue immediately. 

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(Outrage Magazine remains the only publication for the lesbian, gay, bisexual and transgender (LGBT) community in the Philippines.)

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Are the efforts of the Phl gov’t enough for PLHIV?

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Outrage Magazine | 26 May 2014

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HIV

“They should continue talking to different LGBT organizations and different HIV advocacy groups so they will know the real problems.”

That, in a gist, was the plea echoed during the observance of the International AIDS Candlelight Memorial (IACM) this 2014.

IACM is an annual international gathering that commemorates those who passed on because of AIDS. Over the years, it has transformed from being just a memorial to an event where people can also be educated about the HIV pandemic. It’s also a time for different organizations to pledge their support for the PLHIV community.

This year’s gathering, attended by PLHIV from all over the country, different LGBTQ organizations and foundations, was spearheaded by the Project Red Ribbon.

“We did a different twist with the memorial. We wanted to do something more current; we wanted it to be more dramatic. Over the years, other organizations have hosted the event, but it has been just mainly a memorial, and we wanted to change that. We wanted to inspire other PLHIV and the rest of the community that there is still hope and that we need to continue fighting,” said Pozzie Pinoy, founder of the Project Red Ribbon.

As of today, the Department of Health (DOH) remains unsteady when it comes to its programs for PLHIV. The resources that have been allotted to sustain the care and management of PLHIV are lacking, if not fluctuating.

This is even if – when the DOH released its March update on the number of HIV cases in the country – it showed a significant increase in the number of new HIV cases in the country. It seems like the increasing number is (still) not that alarming for the DOH, and so its efforts are (still) wanting.

The same sentiment was shared by the attendees of IACM 2014.

“I think what the government is not doing well is targeting the response to where the epidemic is and that is men who have sex with men. We still need a lot of change in terms of messaging the advocacy and the campaign,” said Benedict Bernabe, CARE officer of Yoga For Life, said.

Yoga For Life is a community-based organization that provides free yoga and meditation classes to PLHIV and to organizations who support PLHIV.

As for the student council of the University of the Philippines, the amount of information being released by the DOH is not enough.

“They should definitely do education first. Information, information, information. Awareness is the key in solving any problem. It’s always the first step in bigger things. Kapag ‘yung information dissemination became successful, we won’t be needing mandatory HIV testing. Kusang darating ang mga tao kapag alam nila kung anong information ang kailangan nila,” said Julian Tanaka, head of USC’s gender committee and councilor of USC.

And of course, there’s the issue of fluctuating supply of ARVs in the country, an issue denied by the DOH several times.

“Ang ARV supplies natin ay wala naman talagang problema. Nagkaroon lang tayo ng abnormal situation because nagkaroon lang ng miscalculations in ordering. Pero hindi nagkaroon ng shortage dahil walang pambili or walang budget. There’s no need to cause unnecessary panic among PLHIV,” Dr. Rosanna Ditangco, research chief at the Research Institute for Tropical Medicine-AIDS Research Group (RITM-ARG, one of the treatment hubs in the country), explained.

At the grassroots, though, this is not what’s coming across.

“The PLHIV community has been panicking for the past three months now. The DOH has not been that transparent with its programs when it comes to antiretroviral medicines. The Project Red Ribbon itself has already purchased ARVs to support the community, so if there’s no problem, why is it that we are buying from other countries to supplement the problems with the stocks?” Pozzie Pinoy stressed in dismay.

Specifically, Project Red Ribbon purchased four boxes of Lamivudine and Tenofovir, a two-in-one mix of the two drugs.

“We were able to release it from the Customs in just one week. So it’s easy to purchase from other countries as opposed to what other people are saying that it’s hard to release it from customs,” Pozzie Pinoy added.

And so the questions remain unanswered:
Are the efforts of the government, especially the DOH, enough to cover the needs of PLHIV?
Are they doing what they are supposed to be doing to control the spread of the virus?
Are they really all talk, with no tangible outputs?
And are they even listening to PLHIV to know what’s really lacking in their existing efforts?

“The DOH should be more transparent about what’s really happening and with their programs. And they should have a continuous dialogue with the PLHIV community before they embark on something drastic that will affect PLHIV significant,” Pozzie Pinoy said.

The IACM event ended with all the attendees gathering around the huge red ribbon cloth while they hold the commemorative candles and as they recite their pledges for the PLHIV community. It was a moment to be remembered, when members of different organizations gathered together to remember those who passed on. But it was also a reminder to everyone that there is still so much more that needs to be done.

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(Outrage Magazine remains the only publication for the lesbian, gay, bisexual and transgender (LGBT) community in the Philippines.)

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