Medicines for chronic diseases: they reduce the discount from 70 to 40% for affiliates in the health system

Using the Resolution of the Ministry of Health, some social and prepaid activities decided to reduce the discounts they apply on drugs used to treat chronic diseases. These prescription drugs, which had for the member a discount of 70% when you buy those prescription drugs, they are already sold but only at a discount of 40%. This is the case with medications for hypertension.

However, they told the Ministry of Health Clarion with no change to the 70% discount on those drugs. And that the Superintendency of Health Services – the regulatory body of the system – should clarify the situation created.

It happens that affiliates in the health system receive messages from social and prepaid projects stating that Resolution 27/2022, of Health, “some drugs will cover 40% and others 70%, if applicable.” For example, drugs based on the drug Candesartan, prescribed alone or in combination with others, to treat high blood pressure, will not appear with a 70% discount on the Ministry of Health’s new list.

According to the Ministry of Health, “Resolution 27/2022 it has nothing to do with the change in coverage percentages in 85 active principles but it establishes reference prices for obtaining these drugs ”. Those 85 active ingredients include some 1,200 pharmaceutical presentations.

Since 2004, “the drug coverage for the most common chronic pathologies has increased from 40% to 70%. (Resolution 310/04 MS, Resolution 758/04 MS and Resolution 82/05 MSyA). In this way, expanded the reference price range of those drugs for chronic diseases with high health impact, requiring permanent and/or repeated use of the drugs ”.

“This measure benefits members of National Social Works, Agents of the National Health Insurance System and partners of prepaid drug companies,” the Ministry reported at the time. And it is detailed, for example, that the most common chronic diseases considered in this new measure include Cardiovascular Diseases and Primary or Secondary Prevention Treatment, such as Essential Arterial Hypertension, Secondary Arterial Hypertension, Heart Failure , Arrhythmias.

In social work and prepaid, they say that “the ministerial resolution establishes that the fixed amount to be covered by the financing agent (social work or prepaid medical entity) is 70 percent of the reference price of drugs containing approved active ingredients. And therefore that is some medications for chronic pain are not on the list of 1,200 pharmaceutical presentationsas in the case of drugs based on the drug candesartan.

In those cases, social activities or prepaid can not cover it, cover it at 40% or 70%, but they are not obliged to make one or another discount, they keep from the sector.

A definition is awaited from the Superintendence of Health Services, the body that manages social and prepaid activities.

In addition, they clarified that by Resolution 27/2022 the coverage of 70% of active ingredients is applied to reference prices. Thus, “if the beneficiary chooses a commercial brand with a higher price, it implies that it will not cover 70% of the selected drug.”