PhilHealth Boosts Breast Cancer Benefit to Php 1.4M in 2024

Effective March 30, 2024, PhilHealth has significantly increased its Z Benefit package for breast cancer to Php 1.4 million, a substantial rise from the previous Php 100,000. This enhancement, as stated in PhilHealth Circular 2024-0007, now covers Stages 0 to 4 of breast cancer and broadens the eligibility criteria, even including patients already undergoing treatment.

PhilHealth President and CEO Emmanuel R. Ledesma Jr. emphasized the importance of this increase, stating,

This significant leap in the Z Benefits Package for breast cancer is proof that PhilHealth is committed to delivering our mandate, to provide responsive benefits to our Kababayans and we will continue implementing benefits that will improve the financial coverage under our thrust Pinalawak at Bagong Benepisyo para sa Mamamayang Filipino.

The package offers a comprehensive approach to breast cancer treatment, covering diagnostic tests, management, and surveillance for early signs of relapse after surgery. The mandatory services have different package rates based on the doctor's recommendation and the patient's requirements. Diagnostic tests and prognostication range from Php 1,000 to Php 10,000; surgical procedures from partial mastectomy to modified radical mastectomy range from Php 30,000 to Php 140,000; hormonotherapy coverage is Php 2,700 or Php 18,000, while cytotoxic chemotherapy ranges from Php 43,000 to Php 185,010. The bulk of the package is allocated to targeted therapy, amounting to more than Php 1 million, translating to Php 333,336 for 18 maximum cycles. Surveillance services range from Php 5,000 to Php 9,000.

To avail of the enhanced Z Benefit Package, members or their qualified dependents should contact the Z Benefits Coordinator at any of the 21 contracted health facilities. The coordinator will guide them through pre-authorization procedures and claims application for reimbursement. PhilHealth also ensures no co-payment for services rendered to patients admitted in basic or ward-type accommodation.

PhilHealth is contracting more qualified health facilities to provide this benefit, making it more accessible to patients in need. Ledesma Jr. expressed hope that this initiative will positively impact the healthcare system in the country.

Reference: Breast cancer benefit now up to Php 1.4 million