Filipinos enrolled in the Philippine Health Insurance Corporation (PhilHealth) can access up to ₱20,000 worth of covered outpatient medicines annually through its Guaranteed and Accessible Medications for Outpatient Treatment (GAMOT) program under the Yaman ng Kalusugan (YAKAP) initiative.
The benefit aims to help ease the financial burden of purchasing essential medicines, particularly for patients managing common and chronic conditions such as hypertension, diabetes, asthma, high cholesterol, respiratory illnesses, and infections.
Under the program, each qualified member and dependent is entitled to an annual medicine benefit limit of up to ₱20,000. However, coverage is limited to medicines included in the official GAMOT list and remains subject to PhilHealth's prescribing and dispensing guidelines.
HOW TO GET YOUR UPSCODE
To access the benefit, members must first register with a PhilHealth YAKAP-accredited primary care facility and undergo a consultation.
Here is how the process works:
1. Register with a YAKAP clinic.
Members must select and register with a YAKAP-accredited healthcare provider. Registration can be done through the eGovPH app, PhilHealth Member Portal, or a PhilHealth Local Health Insurance Office.
2. Visit your chosen clinic for a consultation.
Undergo the required initial patient assessment and consult an authorized YAKAP physician. The doctor will evaluate your condition and determine which medicines are appropriate for your treatment.
3. Request a GAMOT prescription with a UPSC.
If prescribed medicines are covered by the program, the authorized physician will generate an electronic prescription through the PhilHealth GAMOT Application. This prescription contains a Unique Prescription Security Code (UPSC), which verifies its authenticity and allows participating pharmacies to process the transaction.
4. Visit an accredited GAMOT pharmacy.
Bring your GAMOT prescription containing the UPSC and a valid government-issued ID to any participating GAMOT facility to claim your prescribed medicines.
If the medicines are unavailable at your first pharmacy, you may visit another accredited GAMOT facility, provided it can dispense the prescribed medicines.
WHAT IS A UPSCODE?
The Unique Prescription Security Code (UPSC) is a computer-generated code attached to a prescription issued by an authorized YAKAP physician through the PhilHealth GAMOT Application.
It serves as proof that the prescription is valid and allows participating pharmacies to verify the transaction, dispense the prescribed medicines, and monitor how much of the member's annual benefit has been used.
Take note: Members cannot independently generate or obtain a UPSC online, nor can they simply request one from a pharmacy. It must be electronically issued by an authorized YAKAP physician following a medical consultation.
WHAT SHOULD YOU BRING?
Before visiting a participating GAMOT pharmacy, make sure you have:
Your GAMOT prescription containing the UPSC
A valid government-issued ID
If someone else will claim the medicines on your behalf, the representative must also present their valid ID, the patient's valid ID, and an authorization letter.
After every successful transaction, members should receive a GAMOT Availment Slip indicating the medicines dispensed and their remaining annual benefit balance.
NOT ALL MEDICINES ARE COVERED
While the ₱20,000 annual benefit can help reduce out-of-pocket expenses, it does not cover every prescription medicine available in pharmacies.
Only medicines included in PhilHealth's approved GAMOT list are covered. Any medication outside the list or expenses exceeding the remaining annual benefit limit must be paid for by the patient.
Members are encouraged to consult their YAKAP healthcare provider to confirm whether their prescribed medicines qualify for coverage and to check the availability of participating GAMOT pharmacies.
Through YAKAP and GAMOT, PhilHealth aims to make essential outpatient medicines more accessible while helping Filipino families manage their healthcare expenses.