Dumaguete: The Philippine Health Insurance Corp. (PhilHealth) announced that only health facilities accredited under the Yaman ng Kalusugan (YAKAP) program that have met the necessary requirements will be eligible to participate in the Guaranteed and Accessible Medications for Outpatient Treatment (GAMOT) program this year.
According to Philippines News Agency, Ferlyn Catacutan, social insurance officer of PhilHealth-Dumaguete, stated during a Kapihan forum that not all YAKAP facilities have fulfilled the requirements needed for the GAMOT program. "Only compliant YAKAP-accredited facilities can start the GAMOT implementation once this is rolled out in the province soon," Catacutan said in Cebuano.
The rollout of the GAMOT program will occur in phases, with PhilHealth's regional office needing to engage with accredited facilities, including hospitals, clinics, and designated physicians under the YAKAP program. Physicians and pharmacies involved in the GAMOT program must also apply for an online application.
Although Catacutan did not specify an exact date for the official launch of GAMOT, it is anticipated to occur in the early part of 2026, following its initial launch late last year. Some private YAKAP-accredited facilities in the region include Diagcare, Health Care Diagnostic, Negros Polymedic Hospital, ACE Medical Center in Bayawan City, ACE Dumaguete Doctors Hospital in Dumaguete City, and Futalan Medical Clinic in Siaton.
The GAMOT program offers qualified PhilHealth members who have enrolled in YAKAP up to PHP20,000 in medication and/or laboratory examinations annually. PhilHealth members in Negros Oriental are encouraged to register with YAKAP to avail of the GAMOT program once it becomes fully operational. Only registered PhilHealth members are eligible to become YAKAP members.
Meanwhile, Shiela Marie Bacalso, social insurance officer of PhilHealth-Dumaguete, noted that they have yet to contract a health facility in Negros Oriental for cardiovascular cases under the Z Benefit Package. Currently, the nearest contracted facilities for such cases are located in Cebu City, with one in Bohol catering only to newborns with heart diseases.
Despite this, Bacalso highlighted that PhilHealth provides coverage for various heart diseases with increased package rates as of 2025. For instance, Percutaneous Coronary Intervention, previously known as angioplasty, is covered by PhilHealth up to PHP523,000. Patients must undergo pre-screening, evaluation, and communication with the accredited health facility for Z-Ben before accommodation.
