Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City, Metro Manila
NINETEENTH CONGRESS
First Regular Session
HOUSE BILL NO. _______________
Introduced by ANG PROBINSYANO
Party-List Representative Alfred Delos Santos
EXPLANATORY NOTE
Under Article II, Section 15 of the 1987 Constitution, the State is mandated
with “protect[ing] and promot[ing] the right to health of the people.” In relation,
under Article XIII, Section 11, the State has the responsibility of “adopt[ing] an
integrated
and comprehensive approach to health development which shall
endeavor to make essential goods, health and other social services available to all
the people at affordable cost.” The same provision requires the state to “provide
free medical care to paupers.”
Clearly, then, the State needs to provide the health services needed by
Filipinos afflicted by hemophilia: “a rare, in-born, life-long congenital bleeding
disorder, affecting mostly males,” where, “[d]ue to a defective gene, the body…does
not produce enough of certain blood proteins, called clotting factors, which
prevents [the] affected individual from forming a strong and stable blood clot.”1
Without access to treatment, those with hemophilia face the following problems: 1)
[r]epeated bleeding into a joint caus[ing] the synovium (lining) to swell and bleed
very easily,” such that “[o]ver time, most of the cartilage breaks down and some
bone wears away”; 2) “develop[ment of] a form of arthritis, causing joints to be
locked in and permanently deformed”; 3) repeated bleeds causing muscles to
“become weak, scarred, and shorter than normal (sometimes permanently).”2
Hemophilia has become a truly serious health problem in the Philippines, as
reported by the Philippine Council for Health Research and Development (PCHRD),
“a unit under the Department of Science and Technology”:3
The PCHRD identified “two types of hemophilia.” The more common
type is Hemophilia A and the rarer type is Hemophilia B. Both types
have
missing
or
defective
clotting
components:
Factor
VIII
in
Hemophilia A and Factor IX in Hemophilia B. Unfortunately, there is
no cure yet for hemophilia. It is so largely because the condition is
3 Zosimo Literatus, “A morning with hemophilia,” SunStar, April 9, 2019, available at
https://www.sunstar.com.ph/article/1800743/Cebu/Lifestyle/A-morning-with-hemophilia
.
2 Id.
1 Philippine Hemophilia Foundation, Inc., “What is Hemophilia,” available at
http://hemophiliaphilippines.org/blog/hemophilia/.
September 19, 2022
4:24 pm
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hereditary in nature. Thus, once these factors have problems, the
only option is to repair them. However, no one can do that yet.
Now, just when we realize our problem of mapping out hemophilia
among Filipinos, a new form of hemophilia emerged. This type is
called “acquired hemophilia.”
It is difficult to trace the first reported case of acquired hemophilia.
However, research reports in late ‘80s indicate that the case may
have appeared first around mid-20th century.
Acquired hemophilia often manifested as Hemophilia A because the
spontaneous disorder commonly involved Factor VIII. In fact, around
more than half of the cases are idiopathic (of unknown cause) in
origin. Simply put, a disease of unknown origin is a disease of
unknown treatment.
In 2008, the State did take action in aid of those suffering from hemophilia,
through Pres. Gloria Macapal-Arroyo’s Proclamation No. 1478. It recognized the
following circumstances faced by the country with regard to hemophilia: 1) “as of
the year 2005 only about 1,000 or 10% of Filipinos with hemophilia have been
identified so far and over 9,000 remain unidentified and presumed untreated”; 2)
“of these 1,000 Filipino identified with hemophilia, less than 10% of them received
adequate treatment”; and 3) “many of these Filipinos with hemophilia have become
disabled simply because they have no means of paying the exorbitant cost of
medicine
such
as
blood,
plasma,
cryoprecipitate,
cryosupernate and Factor
Concentrate and other therapeutic products.”4 Hence, it enacted the following
measures to begin the process of correcting this situation: 1) declaring the month
April as “National Hemophilia Awareness Month,” with April 17 as “National
Hemophilia Day”;
and 2) designating the Department of Health (DOH) as the lead
agency in “collaborat[ing]/coordinat[ing] with the
Hemophilia Association of the
Philippines for Love and Service (HAPLOS) Foundation, Inc. and the Philippine
Hemophilia Foundation.”5
However, more has to be done. “Out of the 10000 Filipinos that suffer from
hemophilia, 3 out of every 4 people lack the resources required for proper
treatments.”6 Truly, the monetary issues faced by families hit by hemophilia are
alarming. “‘A mild bleed in the joints can cost P30,000 to P50,000 per treatment,”
while “[s]evere bleeds like those in internal organs such as the gastrointestinal tract
or the brain can cost hundreds of thousands, if not millions,’ according to Ric
Felipe, president of the Hemophilia Association of the Philippines for Love and
6 “5 facts you need to know on Hemophilia,” DOST-PCHRD, available at
https://pia.gov.ph/features/articles/1020668.
5 Id.
4 Proclamation No. 1478, s.2008, “DECLARING THE MONTH OF APRIL 2008 AND EVERY
YEAR THEREAFTER AS “NATIONAL HEMOPHILIA AWARENESS MONTH” AND APRIL 17,
2008 AND EVERY YEAR THEREAFTER AS “NATIONAL HEMOPHILIA DAY” AND FOR
OTHER PURPOSES,” available at
https://www.officialgazette.gov.ph/2008/04/03/proclamation-no-1478-s-2008/.


Service (Haplos), the national organization of Filipinos with hemophilia.”7 This is
why you have afflicted families doing through these things:8
Eldie and her husband Orlando…have had to borrow heavily over the
years to raise a fortune for their children’s medical needs.
There are times when they bleed twice a week, so the three boys have
to get an infusion of Factor VIII also called antihemophilic factor
which costs P4,800 per vial. That amounts to around P192,000 a
week for maintenance alone.
If they bleed spontaneously, the younger boys, Miguel, 9 and
Matthew, 5, each need at least two vials every 12 hours, or eight vials
a day. The older Christian will need six vials every 12 hours, or 12
vials a day. If they all bleed at the same time, that amounts to
P96,000 a day.
This bill is offered as a solution to this growing problem. This Bill aims to
ensure that Filipinos with hemophilia will not want for government assistance in
securing the treatments—and even the information—that they need. This bill
provides for: 1) hemophilia treatment facilities; 2) inclusion of hemophilia in
patients assessment tools; 3) inclusion of hemophilia screening in newborn
screening; 4) increase in PhilHealth benefits; and 5) health education and public
awareness drives.
It is for the foregoing premises that the approval of this Bill is earnestly
sought.
ALFRED C. DELOS SANTOS
Representative, Ang Probinsyano Party-List
8 “PCSO extends help to Filipino hemophiliacs,” The Manila Times, April 24, 2018, available
at
https://www.manilatimes.net/2018/04/24/lifestyle-entertainment/life-times/pcso-extends
-help-to-filipino-hemophiliacs/394617/.
7 “Many Filipinos with hemophilia can’t get treatment,” Inquirer, April 20, 2015, available at
https://newsinfo.inquirer.net/686539/many-filipinos-with-hemophilia-cant-get-treatment#
ixzz6Z4IEz5Dk.


Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City, Metro Manila
NINETEENTH CONGRESS
First Regular Session
HOUSE BILL NO. _______________
Introduced by ANG PROBINSYANO
Party-List Representative Alfred Delos Santos
AN ACT
PROVIDING A STANDARD OF CARE FOR THE TREATMENT OF PERSONS
WITH BLEEDING DISORDERS, ESTABLISHING TREATMENT CENTERS, AND
APPROPRIATING FUNDS THEREFOR
Be it enacted by the Senate and the House of Representatives of the
Philippines in Congress assembled:
SECTION 1. Short Title. – This Act shall be known as the “Bleeding Disorder
Standards of Care Act of 2022.”
SECTION 2. Declaration of Policy. – It is hereby declared the policy of the
State:
1) To ensure the adequate treatment of hemophilia at the lowest possible
cost and endeavor to make them available for free to indigent patients;
2) To ensure the establishment of treatment centers in public hospitals; and
3) To establish a standard of care so that patients with severe bleeding
disorders can receive necessary and appropriate medical care.
SECTION 3. Definitions. – The following words and phrases when used in
this Act shall have the meanings given to them in this Section unless the context
clearly indicates otherwise:
a) Bleeding Disorder. – A medical condition characterized by a severe
deficiency or absence of one or more essential blood clotting proteins in
the human blood, often called factors, including all forms of hemophilia,
von Willebrand disease, and other bleeding disorders which result in
uncontrollable bleeding or abnormal blood clotting.
b) Blood
clotting
product.
–
Intravenously
administered
medicine
manufactured
from
human
plasma,
recombinant
biotechnology
techniques, and other processes, approved for distribution by the BFAD
and which is used for the treatment and prevention of symptoms
associated with bleeding disorders. The term includes, but is not limited
to:
1) Factor VIIa, Factor VIII, and Factor IX products;
2) Von Willebrand Factor products;
3) Prothrombin complex concentrates;
4) Activated prothrombin complex concentrates;
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5) Other products are approved by the BFAD for the treatment of
bleeding disorders and associated inhibitors.
c)
Indigent Patient. – Any patient deemed unable to pay for services and/or
medical
treatment,
laboratory
testing
of
blood
and/or
coagulation
studies,
or
blood
coagulating
products
and/or
ancillary
infusion
equipment.
d) DOH. – Department of Health
e)
BFD. – Bureau of Foods and Drugs
f)
Hemophilia.
– A human bleeding disorder caused by a hereditary
deficiency of the Factor VIII, Factor IX, or Factor XI blood clotting protein
in human blood.
g) von Willebrand disease. – A human bleeding disorder caused by a
hereditary deficiency or abnormality of the von Willebrand Factor in
human blood.
SECTION 4. Hemophilia Treatment Facilities. –
The State shall establish
hemophilia treatment facilities in key cities and regions nationwide in designated
hospitals with Cancer and Hematology Departments.
Each Hemophilia Treatment Facility shall provide to all hemophilia patients:
1) Care by qualified hematologists and medical doctors and shall also
provide free of charge the necessary blood clotting products and ancillary
infusion equipment necessary for the infusion of such blood clotting
products;
2) A room exclusively for hemophilia patients; and
3) A clinical coagulation laboratory for the screening, diagnosis, provision
diagnosis, and treatment of bleeding disorders or suspected bleeding
disorders and such services shall be provided free of charge to all
indigent patients.
SECTION
5.
Inclusion
of
Hemophilia
in
Patients Assessment Tools. –
Hemophilia and other bleeding disorders shall be included in patients’ history and
assessment tools including familial history and history or presence of bleeding
episodes.
SECTION 6. Inclusion of Hemophilia Screening in Newborn Screening. –
Screening tests for hemophilia shall be included in the comprehensive newborn
screening tests.
SECTION 7. Increase in PhilHealth Benefits. – PhilHealth shall review and
increase as appropriate based on the recommendations of the DOH and Hemophilia
patients group on the benefit for bleeding disorders. The benefits package shall
include, among others, blood transfusion and/or injection of blood coagulating
products, and laboratory and diagnostic procedures.
SECTION 8. Health Education and Public Awareness. – The DOH shall
provide educational materials to increase public awareness of hemophilia and other
bleeding disorders.
SECTION 9. Funding. – The amount necessary for the initial implementation
of this Act shall be sourced from the current budget of the DOH. Thereafter, the
funds necessary for the continuous implementation of this Act in the ensuing years
shall be included in the General Appropriations Act.


The treatment facilities are allowed to use five percent (5%) of the amount
given to them for the maintenance of the rooms that will be used exclusively for
hemophilia patients. However, ninety percent (90%) of the amount shall be used
exclusively for necessary blood clotting products and ancillary infusion equipment
necessary for the infusion of such blood clotting products to hemophilia patients.
The remaining five percent (5%) shall be used for blood screening of hemophilia
patients.
Each treatment facility shall submit an annual report to the DOH on how
the amount given to it is used.
SECTION 10. Regulations. – Within sixty (60) days from the approval of this
Act, the DOH shall, in consultation with hemophilia groups, promulgate the
Implementing Rules and Regulations (IRR) to carry out the provisions of this Act.
SECTION 11. Separability Clause. – If any provision of this Act shall be
declared unconstitutional or invalid, such declaration shall not invalidate other
parts thereof which shall remain in full force and effect.
SECTION 12. Repealing Clause. – All laws, executive orders, presidential
decrees or issuances, letters of instruction, administrative orders, rules, and
regulations contrary to or inconsistent with the provisions of this Act are hereby
repealed, amended, or modified accordingly.
SECTION 13. Effectivity Clause. – This Act shall take effect fifteen (15) days
after its publication in the Official Gazette or in a newspaper of general circulation.
Approved,