Thursday, September 20, 2007
Bill - Hon. Don Emmanuel L. Nolasco
Republic of the Philippines
Third Youth Congress
Baguio City
First Regular Session
House Bill No.
Hon. Don Emmanuel L. Nolasco
EXPLANATORY NOTE
True to the Constitutional directive to adopt an integrated and comprehensive approach to health development by making essential goods, health and other social services available to all people at affordable cost, Republic Act 7875 established the Philippine Health Insurance Corporation (PHILHEALTH) in 1995. The PHILHEALTH was empowered to implement a National Health Insurance program, which in rurn, was envisioned to provide the mechanism by which citizens, especially those who cannot afford to do so, can gain financial access to health services through a government subsidized health insurance system.The package of benefits under the Program includes services of health care professionals, diagnostic and examination services, use of medical and surgical equipment and facilities, education, and preventive services, emergency and transfer services, prescription drugs and biological, and other health care services. Fund sources to pay for these services include the contribution of members, donations and grant-in-aids, earmarked appropriations, and accruals thereof. PHILHEALTH'S total paid benefit payment claims totaled PhP8.84B in 2002, PhPl0.96 B in 2003' and php6.19 B in the first semester of 2004. Of these claims, drugs and medicines comprised an average of 30o/o of the total benefits paid, making pharmaceuticals the biggest medical reimbursement fund for Philhealth.It has, however, been shown that the price of drugs and medicines in the Philippines is considered as one of, if nor the highest in the ASEAN Region. The recent study of the World Health Organization/Health Action International (WHOAIAI) showed that prices of all the 36 medicines surveyed in the Philippines were higher than the International Reference Price. That study also showed that the mean price ratio for particular medicines is as much as 20 times higher than our ASEAN neighbors.The exorbitant prices of medicines in the country is in itself a problem from which we need specific, effective, and immediate relief. In the light of the National Health Insurance Program, this is the Fair Pricing in Pharmaceuticals Act of 2006 aims to establish the fair price to be used for the reimbursement of drugs and biological benefits paid by Philhealth by expanding its Powers to include the price monitoring of drugs and biologicals listed in the Philippine National Drug Formulary or covered by any existing benefit package or reimbursable list of the National Health Insurance program, the determination of the fair and proper price for the listed drugs and biologicals being monitored, and'the dissemination of the determined fair prices to the general public, national and local government agencies, health institutions and the health industry.It is hoped that by ensuring that the drugs and biologicals being reimbursed by Philhealth will not be overpriced, Philhealth disbursements can be made more cost-effective and its financing be assured a grearer degree of sustainability. More importantly, the freeing up of Philhealth funds will help it provide access to better health care services to the widest possible population. For this reason, the immediate Passage of this bill is earnestly sought.
Hon. Don Emmanuel L. Nolasco
YOUTH CONGRESS
Quezon City, Metro Manila
THIRD YOUTH CONGRESS
House Bill No.
Introduced by Hon. Don Emmanuel L. Nolasco
AN ACTESTABLISHING A FAIR PRICING SYSTEM FOR DRUGS, BIOLOGICALS, MEDICINES, ANDHEALTH CARE SERVICES TO BE REIMBURSED BY THE PHILIPPINE HEALTH INSURANCECORPORATION (PHILHEALTH), AMENDING FOR THIS PURPOSE REPUBLIC ACT NO. 7875,OTHERWISE KNOWN AS "THE NATIONAL HEALTH INSURANCE ACT OF 2007."
Be it enacted by the Senate and House of Representatives of the Philippines in Congress assembled:
SECTION 1. Short Title. - This Act shall be known as the "Fair Pricing in Pharmaceuticals Act of 2007
SECTION 2. Declaration of Policy. - It is hereby declared the policy of the State to endeavor to make health, essential goods, medicines, and other social services available to all the people at affordable cost. It is likewise the policy of the State to ensure that the National Health Insurance Program (the "Program") incorporates features of cost containment in its designand operations, and continuously ensures that the charges by health care providers arereasonable and the costs borne by the members are fair and equitable. For this purpose, the State shall ensure that the cost of drugs, biologicals, and other medicines to be reimbursed by the Philippine Health Insurance Corporation ("the Corporation") shall be fairly priced.
SECTION 3. Definition of Terms. - As used in this Act, the following terms are defined as follows:
(a) Benefit Package - refers to services that the Program offers to its members.
(b) Biologicals - refers to biological products (such as globulin, serum, vaccine, antitoxin, or antigen) used in the prevention or treatment of disease.
(c) Coverage - refers to the entitlement of an individual, as a member or as a dependent, to the benefits of the Program.
(d) Diagnostic Procedure - refers to any procedure to identify a disease or condition through analysis and examination.
(e) Fair Price - refers to the price of drugs and biologicals listed in the Philippine National Drug Formulary, or covered by any existing benefit packaging or reimbursable list of the National Health Insurance Program,which price shall be determined by the Corporation in accordance with the mechanisms provided for under Section 6 of this Act.
(f) Health Care Provider - refers to:
(a) a health care institution, which is duly licensed and accredited devotedprimarily to the maintenance and operation of facilities for health promotion,prevention, diagnosis, treatment, and care of individuals suffering from illness,disease, injury, disability or deformity, or in need of obstetrical or other medicaland nursing care. It shall also be construed as any institution, building, or placewhere there are installed beds, cribs, or bassinets for twenty-four hour use orlonger by patients for the treatment of diseases, injuries, deformities, or abnormalphysical and mental states, maternity cases or sanitarial care; or infirmaries,nurseries, dispensaries, and such other similar names by which they may bedesignated;
(b) a health care professional, who is any doctor of medicine , nurse, midwife,dentist, or other health care professional or practitioner duly licensed to practicein the Philippines and accredited by the Corporation;
(c) a health maintenance organization, which is an entity that provides, offers,or arranges for coverage of designated health services needed by plan members fora fixed prepaid premium; or(d) a community-based health care organization, which is an association ofindigenous members of the community organized for the purpose of improvingthe health status of that community through preventive, promotive and curativehealth services.
(g) Median Price Ratio - refers to the ratio of the local price to the international reference price(IPR) converted into the same currency. The international reference price sha ll pertain to themedian of recent procurement supply prices or tender prices offered by suppliers todeveloping countries for multi-source products, as recommended by the World HealthOrganization and Health Action International.
(h) Pharmaceutical - refers to a substance used in the diagnosis, treatment, or prevention ofdisease and for restoring, correcting or modifying organic function.
(i) Philippine National Drug Formulary - refers to the essential drugs list for the Philippineswhich is prepared by the National Formulary Committee of the Department of Health inconsultation with experts and specialists from organized professional medical societies,medical academe and the pharmaceutical industry, and which is updated every year.
(j) Prescription Drug - refers to a drug which has been approved by the Bureau of Food andDrug and which can be dispensed only pursuant to a prescription order from a physician whoBenefit Package. - Subject to the limitations specified in this Act and ass duly licensed to do so.disease.follows:"Section 10. Benefit Package. - Subject to the limitations specified in this Act and asshall be determined by the Corporation, the following categories of personal health services granted to the member or his dependents as medically necessary or appropriate, shall include:
(a) Inpatient hospital care:
(1) room and board;
(2) services of health care professionals;
(3) diagnostic, laboratory, and other medical examination services;
(4) use of surgical or medical equipment and facilities;
(5) prescription drugs and biologicals; subject to the limitations stated inSection 37 AND SECTION 38 of this Act;
(6) inpatient education packages;
(b) Outpatient care:
(1) services of health care professionals;
(2) diagnostic, laboratory, and other medical examination services;
(3) personal preventive services; and
(4) prescription drugs and biologicals, subject to the limitations described inSection 37 AND SECTION 38 of this Act;SECTION 5. Section 16 of Republic Act No. 7875 is hereby amended to read as follows:xx x"
(p) to keep records of the operations of the Corporation and investmentsof the National Health Insurance Fund; [and]to perform such other acts as it may deem appropriate for the
(q)attainment of the objectives of the Corporation and for the proper enforcement ofthe provisions of this Act;
(R) TO CONDUCT REGULAR PRICE MONITORING OF ALL DRUGSAND BIOLOGICALS LISTED IN THE PHILIPPINE NATIONAL DRUGFORMULARY OR COVERED BY ANY EXISTING BENEFIT PACKAGE ORREIMBURSABLE LIST OF THE NATIONAL HEALTH INSURANCE PROGRAM;TO DETERMINE AND ESTABLISH THE FAIR PRICE FOR THE (S)LISTED DRUGS AND BIOLOGICALS BEING MONITORED; AND(T) TO DISSEMINATE THE DETERMINED FAIR PRICE OF DRUGSAND BIOLOGICALS TO THE GENERAL PUBLIC, NATIONAL AND LOCALGOVERNMENT AGENCIES, HEALTH INSTITUTIONS AND THE HEALTHINDUSTRY."SECTION 6. Section 38 of Republic Act No. 7875 is hereby amended to read as follows:"Section 38. Safeguards Against Over and Under Utilization AND OVERPRICING OFDRUGS AND BIOLOGICALS. - It is incumbent upon the Corporation to set up a monitoringmechanism to be operationalized through a contract with health care providers to ensure thatthere are safeguards against:
(a) over-utilization of services;
(b) unnecessary diagnostic and therapeutic procedures and intervention;
(c) irrational medication and prescriptions;
(d) under-utilization of services; [and]
(e) inappropriate referral practices; AND
(f) OVERPRICING OF DRUGS AND BIOLOGICALS.THE CORPORATION MAY DENY OR REDUCE THE PAYMENT FOR CLAIMS WHENSUCH CLAIMS ARE ATTENDED BY FALSE OR INCORRECT INFORMATION AND WHEN THECLAIMANT FAILS, WITHOUT JUSTIFIABLE CAUSE, TO COMPLY WITH THE RULES ANDREGULATIONS OF THIS ACT.THE CORPORATION, IN COMPLIANCE WITH THE PRINCIPLES OF RESPONSIVENESS,EFFECTIVENESS, AND FIDUCIARY RESPONSIBILITY AS STATED IN SECTION 2 OF REPUBLICACT NO. 7875 AND THIS ACT, IS HEREBY MANDATED TO DESIGN AND IMPLEMENTPOLICIES, PROCEDURES AND OTHER MEASURES TO ENSURE THAT ONLY FAIR-PRICEDDRUGS AND BIOLOGICALS ARE QUALIFIED AS PART OF ANY BENEFIT PACKAGE UNDERTHIS ACT. THE CORPORATION SHALL ALSO ENSURE THAT NO DISRUPTIONS IN SUPPLYFOR BENEFICIARIES SHALL OCCUR AS A RESULT OF THESE MEASURES, INCLUDING APOLICY OF COVERING ALL DRUGS AND BIOLOGICALS DEFINED IN SECTION 37 WITHIN ANEXTENDED PERIOD OF TIME NOT EXCEEDING SEVEN YEARS.THE CORPORATION SHALL DETERMINE THE FAIR PRICE OF DRUGS ANDBIOLOGICALS PERIODICALLY USING ONE OR MORE OF THE FOLLOWING MECHANISMS:1) COMPETITIVE BIDDING;2) PRICE COMPARISONS WITH THREE OR MORE COUNTRIES INTHE ASEAN REGION THAT ARE RELATIVELY AT PAR WITH THEPHILIPPINES IN TERMS OF SOCIO-ECONOMIC DEVELOPMENT;3) PRICE COMPARISONS WITH TRANSACTIONS DONE BYINTERNATIONAL BODIES, DONOR AGENCIES, AND OTHERSIMILAR INTERNATIONAL DEVELOPMENT AGENCIES;4) PRICE-VOLUME NEGOTIATIONS WITH MANUFACTURERS FORSINGLE-SUPPLIER PRODUCTS;5) USE OF MEDIAN PRICE RATIOS (MPR'S) AS RECOMMENDED BYTHE WORLD HEALTH ORGANIZATION AND HEALTH ACTIONINTERNATIONAL.THE CORPORATION SHALL ENSURE THE PUBLICATION OF UP-TO-DATE PRICELISTINGS OF FAIR PRICES OF DRUGS AND BIOLOGICALS IN VARIOUS NEWSPAPERS OFNATIONAL CIRCULATION, ON THE CORPORATION'S WEBSITE, AND POSTERSPROMINENTLY DISPLAYED IN PHARMACIES AND HOSPITALS ON A REGULAR BASIS. THECORPORATION SHALL LIKEWISE ENSURE THAT PRINTED COPIES OF THE FAIR PRICE LISTARE DISTRIBUTED TO ALL ACCREDITED HEALTH CARE INSTITUTIONS AT LEAST ONCE AYEAR.
SECTION 7. Extended Period of Coverage. - The extended period for coverage of all drugs andbiologicals in the measures defined in Section 4, 5 and 6 shall commence from the effectivityof this Act.
SECTION 8. Separability Clause. - If any section or provision of this Act shall be declaredunconstitutional or invalid, the other sections or provisions not affected thereby shallcontinue to be in full force and effect.
SECTION 9. Repealing Clause. - All laws, presidential decrees, executive orders, rules and regulationsor parts thereof which are inconsistent with the provisions of this Act are hereby repealed,amended or modified accordingly.
SECTION 10. Effectivity. - This Act shall take effect fifteen (15) days after its publication in at least(3) national newspapers of general circulation.
APPROVED,
Hon. Don Emmanuel L. NolascoLabels: health
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