GAMOT Fixed Fees: How Medicine Pricing Works (PC 2025-0013 Annex A.2)

Under PhilHealth GAMOT, every dispensed medicine preparation is priced at one fixed, government-set fee — not the pharmacy's usual retail price. That fee comes from Annex A.2 of PhilHealth Circular No. 2025-0013, which lists 242 numbered drug preparations tied to specific peso amounts — the actual figure PhilHealth reimburses the dispensing facility.

If you run or manage a YAKAP clinic, or you're weighing whether your pharmacy should apply as a GAMOT Facility, the fixed fee model matters more than memorizing the medicine list — it determines reimbursement, inventory economics, and what a patient can be charged once their benefit runs out.

What "Fixed Fee" Actually Means

A fixed fee is a single standard rate per drug preparation that PhilHealth pays for, regardless of a pharmacy's usual retail markup. PC 2025-0013 defines the Fixed Fee Schedule as "a set of standard rates per specific drug preparation to be dispensed and shall be the basis of a prescription's cost."

Two things follow from that definition:

The fee is per preparation, not per molecule. Amlodipine isn't one fee — 5mg and 10mg tablets are two separate line items, because dose strength, form (tablet, capsule, syrup, inhaler, nebule), and pack size all change the preparation.
The fee is nationwide and uniform. A GAMOT Facility in Batanes and one in Davao bill PhilHealth the same amount for the same preparation — there's no regional or facility-specific pricing tier.

This is also why Annex A.2 (242 preparations) is longer than Annex A.1, the actual GAMOT medicine list (75 molecules across 8 therapeutic categories) — one molecule commonly appears two or three times in the fee schedule, once per dose strength or formulation a clinic or pharmacy actually stocks.

Example Fixed Fees From Annex A.2

The schedule spans roughly ₱1.25 to nearly ₱2,000 per preparation, depending on drug class. A sample, drawn directly from PC 2025-0013:

Amlodipine 5mg tablet — ₱4.50
Amlodipine 10mg tablet — ₱6.50
Losartan 50mg — ₱9.00
Losartan 100mg — ₱12.00
Metformin 500mg film-coated tablet — ₱4.75
Metformin 850mg — ₱5.25
Paracetamol 500mg tablet — ₱2.25
Amoxicillin 500mg capsule — ₱5.25
Azithromycin 500mg tablet — ₱74.25
Oseltamivir 75mg capsule — ₱110.00
Fluticasone+Salmeterol 500/50mcg x60-dose DPI — ₱1,981.75 (the most expensive single preparation on the schedule)
Iron (ferrous salt) 60mg elemental tablet — ₱1.25 (one of the cheapest)

The pattern: routine maintenance tablets for hypertension, diabetes, and dyslipidemia sit in the single digits to low teens; antibiotics and antivirals climb into the tens to low hundreds; maintenance inhalers for asthma/COPD are by far the most expensive items on the list. That's the cost structure a clinic is planning around when deciding which GAMOT molecules to prioritize — high-volume, low-cost maintenance drugs versus low-volume, high-cost respiratory preparations.

How the ₱20,000 Annual Benefit Limit Interacts With Fixed Fees

The fixed fee schedule and the Annual Benefit Limit (ABL) work together as one system: each dispensed preparation is deducted from a beneficiary's ₱20,000 yearly balance at its fixed fee, not at retail price. PC 2025-0013 sets the ABL at ₱20,000.00 per beneficiary, and beneficiaries pay nothing out of pocket until that balance is exhausted.

The ABL resets every January 1 to the full ₱20,000 — unused balance from the prior year is not carried over.
Because deductions run at the fixed fee, the same ₱20,000 stretches much further on cheap maintenance drugs (e.g., dozens of Amlodipine 10mg fills at ₱6.50 each) than on a handful of respiratory inhalers at nearly ₱2,000 apiece.
Maintenance medications can be prescribed for up to 3 months but are dispensed monthly — a 1-month supply, with the next released starting 2 weeks after the previous dispensing — so the fee is charged against the ABL incrementally, not all at once.

For patient expectations, this is a useful framing: it's not "₱20,000 worth of medicine" subjectively, it's ₱20,000 measured against the same government price list every facility uses.

What Happens After the ABL Is Consumed

Once a beneficiary's ₱20,000 is used up, they pay out of pocket, but the GAMOT Facility must still charge at the same fixed fee — it cannot revert to normal retail markup. The exception is a beneficiary who specifically prefers a branded medicine priced above the schedule, which falls outside GAMOT coverage entirely. Mandatory senior citizen and PWD discounts, plus VAT exemption, still apply on these post-ABL transactions — so in practice the fixed fee is a price ceiling year-round, not just while PhilHealth is paying.

GAMOT never covers, at any price: medications consumed during confinement or outpatient emergency care, branded medicines priced above the schedule, drugs already covered by other outpatient benefit packages, and Philippine National Formulary drugs not on the GAMOT List.

What This Means for Clinics and Pharmacies

For a YAKAP clinic, the fixed fee schedule is a prescribing and patient-education issue — the dispensing pharmacy bills PhilHealth, but prescribing choices determine how fast a patient's ABL depletes. For a pharmacy weighing accreditation, the schedule is the reimbursement rate card:

PhilHealth pays at the published fixed fee, disbursed via the Auto-Credit Payment Scheme directly to the facility's deposit account — no per-drug negotiation.
Coverage requires an e-prescription issued through the GAMOT App with a Unique Prescription Security Code (UPSC), ICD-10 diagnosis coding, and the physician's license details.
Dispensing windows are strict: anti-infectious medicines within 2 days of prescription, other medicines within 2 weeks; the prescription expires 90 days after issuance if unclaimed.
Pharmacies must declare dispensable preparations (a Certification of Availability) and keep them stocked — the fee schedule doubles as a stocking checklist during accreditation.
Accreditation is pharmacy-friendly on cost: no pre-accreditation survey required, and the fee is waived for the program's first three years.

For a deeper walkthrough of accreditation, see How Pharmacies Join PhilHealth GAMOT. If you're still mapping which of the 75 GAMOT molecules apply to your patient panel, the GAMOT Medicine List breaks the full formulary down by category, and E-Prescriptions Under GAMOT covers the UPSC/GAMOT App mechanics in detail.

How RecordKo Handles GAMOT Pricing End-to-End

RecordKo is built for the YAKAP/GAMOT workflow from prescription to claim, not just note-taking. Doctors record diagnoses with ICD-10 coding and generate ePresS electronic prescriptions with the physician's PRC/PTR/S2 details already attached, so the prescription reaching the GAMOT App is complete on the first pass. RecordKo also runs the PCU liveness check at registration and consultation, logs the transaction number, and builds the encrypted T1/T2 XML claim files that PhilHealth's validateReport/submitReport endpoints expect — each consultation gets its own transmittal number, so duplicate submissions are caught before they become a rejected claim. For clinics migrating off eKonsulta, RecordKo also handles XML batch import and export, so historical Konsulta records carry over instead of starting from zero. It's designed for the certified-EMR era YAKAP is moving toward, end-to-end.

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