By Emiliano M. Manahan Jr.
The expansion of the PhilHealth YAKAP-GAMOT (Guaranteed and Accessible Medications for Outpatient Treatment) benefit is a welcome development. Adding 54 medicines to the original 21 brings the total to 75 medicines that qualified beneficiaries may avail of within the ₱20,000 annual allocation per beneficiary for free medicines.
For senior citizens, persons with disabilities (PWDs), and Filipinos living with chronic illnesses, this assistance can make a real difference.
But an important question must be asked: Is the benefit truly accessible to those who need it most?
A health benefit should not merely exist on paper. It should be practical and responsive to beneficiaries’ actual medical needs.
When the medicines on the list are not the medicines the patient needs
The inclusion of 75 medicines spans a wide range of common medical conditions, marking a welcome expansion of access. This development is especially beneficial for first-time patients, those relying mainly on primary care, or individuals who have previously been outside the reach of medical services. Yet, while a standardized list offers broad coverage, it cannot fully meet the needs of patients with advanced illnesses or those requiring specialized treatment.
Consider an elderly patient taking ten maintenance medications prescribed by her physicians across various specialties who have been treating her for years. If only one of those ten medications is on the GAMOT list—and it happens to be the cheapest—the patient may technically have a ₱20,000 benefit but receive very little meaningful financial assistance.
This is particularly concerning because patients with multiple or complex medical conditions may be the very ones who need financial support most. Their medicines may be more specialized, more expensive, or simply not included in the current PhilHealth list.
The issue is not about demanding a particular brand. It is about recognizing that some patients’ medical needs no longer fit a basic list of commonly used medicines.
What about patients under non-YAKAP doctors?
Many elderly patients and patients with chronic conditions have long been under the care of trusted physicians who may not be accredited YAKAP doctors. These physicians know their patients’ medical history and treatment response.
Why, then, should access to a beneficiary’s medicine benefit depend exclusively on consultation with a YAKAP-accredited physician?
There should certainly be safeguards against inappropriate prescribing and abuse. But safeguards need not mean excluding prescriptions from other qualified and licensed physicians. A system could be developed to recognize such prescriptions, subject to appropriate PhilHealth verification.
Accessibility is also affected by the limited availability of YAKAP doctors, who may be assigned only on particular days and hours in selected health centers. This can be especially difficult for elderly persons, PWDs, and patients with mobility limitations.
PhilHealth should likewise ensure that covered medicines are readily available through a wider network of accredited pharmacies nationwide. If a medicine is covered, beneficiaries should not have to visit several pharmacies just to find it.
Make YAKAP truly inclusive
PhilHealth deserves credit for expanding the GAMOT list. But the next step should be greater flexibility.
PhilHealth should consider:
1. Accrediting more YAKAP doctors, clinics, and hospitals to improve accessibility;
2. Recognizing prescriptions from other qualified and licensed physicians, subject to reasonable safeguards;
3. Creating a mechanism for medically necessary medicines not included in the standard list, particularly for patients with chronic, complex, or multiple conditions, subject to medical justification or prior authorization; and
4. Expanding the network of accredited pharmacies nationwide.
The objective is not to weaken YAKAP or remove safeguards. It is to make the program work better for those it was created to serve.
As an advocate for marginalized sectors, particularly senior citizens and PWDs, I believe government health programs should be judged not only by the size of their allocation or the number of medicines listed, but by their actual impact on beneficiaries.
A ₱20,000 benefit that a patient cannot meaningfully use is not the same as ₱20,000 worth of medical assistance.
The expansion to 75 medicines is a good beginning. Flexibility should be the next step.
Let YAKAP provide not merely a promise of assistance, but assistance that beneficiaries can actually use—especially those who need it most.
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