Health plan provides for discharge with R$ 6 million medicine – 02/13/2023 – Panel SA

Entities representing health plan operators claim that the price of the service may skyrocket after the ANS (sector regulatory agency) approved the incorporation of Zolgensma, by Novartis, in the list of covered drugs.

The maximum price of the medicine defined by Cmed (Chamber of Regulation of the Medicines Market) exceeds R$ 6 million. The product is used in the treatment of children up to six months old diagnosed with AME (Spinal Muscular Atrophy) type 1.

“In a market where there are almost 700 operators, 21% of them do not earn this amount in the year [somados os impostos]. If a child has this disease, it will break the carrier. Supplementary health works on the mutualism model: everyone pays for whoever needs to use it. People will not be able to pay compatible monthly fees to access such expensive products”, says Vera Valente, executive director of Fenasaúde (which brings together companies such as Amil, Bradesco Saúde, Golden Cross and SulAmérica).

Valente says he is not opposed to the funding of the drug by health plans, but he defends the discussion of alternatives for the sustainability of companies, such as risk sharing, in which payment for offering the drug in the network is conditional on the patient’s improvement.

Sought by Panel SA, ANS said that risk sharing is an agreement made between the buyer and the pharmaceutical industry and that it is not up to the agency to negotiate prices.

Alessandro Acayaba de Toledo, president of Anab (association of benefit administrators), also says that the incorporation of Zolgensma could lead to financial instability for some operators.

“If you take a small operator that has an application of a drug like that without having a very good financial support, it compromises the stability of the operator and, consequently, this value ends up being passed on in the readjustment to consumers of health plans. Our concern is that situations like this start to come on a very big scale”, he says.

Joana Cunha with Paulo Ricardo Martins It is Diego Felix

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