Rondineli Mendes da Silva

Aquisição de medicamentos para a Doença de Alzheimer no Brasil: uma análise no sistema federal de compras, 2008 a 2013

The demographic transition in Brazil has led to substantial aging of the population and an increased prevalence of age-related diseases such as dementia and Alzheimers Disease (AD). The Brazilian Ministry of Health finances AD medication and, since 2002, a Clinical Protocol and Therapeutic Guidelines (PCDT) for this condition have been made available. This study investigated the acquisition of medication for AD in the Integrated System of Administration of General Services (SIASG) database. A profile of purchases, expenditures and prices from 2008 to 2013 was prepared. All medication and forms of treatment of AD were investigated, including those not contained in the PCDT protocol. Unit prices were deflated to December 2013 by the IPCA (Brazilian Pricing Index). More than 47 million units of medication for AD were acquired and expenditures attained 90.1 million Brazilian reals. The purchase of the various administration routes of rivastigmine were in the forefront. Medication not listed in the protocol represented 3% of expenditures and purchases resulting from health litigation were negligible. Over the period, a reduction of corrected weighted average prices of PCDT and non-PCDT medication was observed.

Análise dos investimentos do Ministério da Saúde em pesquisa e desenvolvimento do período 2000-2002: uma linha de base para avaliações futuras a partir da implementação da agenda nacional de prioridades de pesquisa em saúde

The aim of this paper is to examine the Ministry of Health of Brazil investments in research and development in health (R&D/H) between the years of 2000-2002, trying to contrast them with the items of the National Health Research Priority Agenda, in order to attempt a base line that makes capable future evaluations on the inductor role. The data was collected by a research carried out with the main goal of measure resources invested in R&D/H in the country on the period, considering only the Ministry of Health investments. The researches were independently categorized by 2 researchers based on 24 subdivisions which compose the Agenda. The amount of the resources invested by the Ministry of Health on the period was of R

Incorporação de novos medicamentos pela Comissão Nacional de Incorporação de Tecnologias do SUS, 2012 a junho de 2016

199.3 millions. Most of the expense was related to researches in transmittable diseases (31.5%), followed by systems and policies in health (16.3%) and communication and information in health (8.6%). Conditions that represent a substantial disease burden (non transmittable diseases, mental health, violence, accidents and traumas, elderly person health) received relative small amount of resource. The work establishes a starting point from which managers of scientific and technological policy may assess the progressive influence of the Agenda and the reduction of the identified imbalances.

Política Nacional de Medicamentos em retrospectiva: um balanço de (quase) 20 anos de implementação

The National Commission for incorporation of Health Technologies (CONITEC), established in 2011, advises the Ministry of Health in decisions related to the incorporation, exclusion or change of medicines, products and procedures in the Unified Health System (SUS).The study investigated the decision-making process, profile of demands and incorporation of new medicines in the SUS from January/2012 to June/2016, based on data available on the CONITEC website. All submissions were evaluated and characterized by technology and applicant type. The incorporations were analyzed according to the Anatomical-Therapeutic-Chemical classification, International Classification of Disease of the clinical indication and active record in the National Health Surveillance Agency. In the period, 485 submissions were received, 92.2% concerning requests for incorporation and 62.1% for medicines, of which 93 (30.1%) received a favorable recommendation for incorporation. Domestic demands were more successful than externally originated ones. Six unregistered drugs were incorporated. Infectious and parasitic diseases and musculoskeletal diseases constituted the main clinical indications. The recommendation of incorporation occurred mainly based on the additional clinical benefits and low budget impact.

Assistência farmacêutica no município do Rio de Janeiro, Brasil: evolução em aspectos selecionados de 2008 a 2014

Resumo A assistencia farmaceutica (AF) e a formulacao de politicas de medicamentos sao campos de atuacao do Sistema Unico de Saude (SUS). Assim, em 1998, apos um processo participativo, a Politica Nacional de Medicamentos (PNM) foi aprovada e publicada em portaria. A PNM traz em seu cerne, baseadas nos principios e diretrizes do SUS, diretrizes e prioridades para balizar as acoes das tres esferas de Governo no alcance do objetivo essencial da politica. A fim de conduzir o leitor a momentos de reflexao sobre esse periodo de vida da politica, o artigo se propoe a fazer um balanco dos quase 20 anos da PNM, com a discussao de algumas diretrizes especificas a luz de principios do SUS. Nao se pretendeu exaurir todas as atividades do periodo, mas aproximar se daquelas que se destacaram por apontar avancos e dilemas, com potenciais riscos de retrocessos. Vislumbrou-se esforcos de implementacao de uma agenda ambiciosa para a AF, que tentou lidar com desafios de enfrentamento do mercado farmaceutico, da operacionalizacao da AF dentro do SUS. Apesar dos principios do SUS serem reconhecidos nas diferentes iniciativas, identifica-se tambem que a operacionalizacao traz uma serie de contradicoes e riscos que podem comprometer alguns desses principios.Pharmaceutical services and the formulation of a medicines policy are SUS areas ensured by the organic health care law 8,080/90. Thus, after a widely participative process, involving stakeholders, the National Medicines Policy (NMP) was approved in 1998 by Ordinance 3,916.The NMP presents directives and priorities, aligned with organic health care law, which should guide the federal, states and municipals entities actions to achieve the policy goals. Considering almost 20 years of the NMP, this paper took stock discussed some of the directives in light of the SUS principles. It was not the objective to provide an exhaustive review of all the activities performed during this period. The authors tried to get close to those that have brought advances and dilemmas, with potential risk of regression. Efforts to implement an ambitious agenda applied to pharmaceutical services were identified. This agenda tried to deal with different challenges like the dynamics of the pharmaceutical market and the operation of pharmaceutical services to guarantee the supply of medicines aligned with principles and directives of SUS.

Farmácia Popular Program: pharmaceutical market analysis of antihypertensive acting on the renin-angiotensin system medicines

This article aims to analyze the development of pharmaceutical services in the context of the primary health care (PHC) in the period 2008- 2014, focusing on selection, procurement and financing of medicines. A retrospective study was undertaken, using as data sources administrative documents of Rio de Janeiro Municipality Health Secretariat (SMS-RJ) as well as secondary database. We found a growth of numbers medicines offered for PHC of 57 items in 2008 to 222 in 2014. Actual spending on drugs paid by the city has grown 38% in the period, with a reversal from 2010, of the proportion of PHC related to tertiary care drugs, reaching 2.4 times in 2014, the year that public spending on medicines per capita of PHC was 9% greater than the value agreed between the three federal levels. It can be concluded that there have been important changes in pharmaceutical services in Rio de Janeiro Municipality in the period following the reform of PHC held in this territory, with increasing the conditions for therapeutic coverage and increased drug funding. The growth of per capita public spending on medicines above the agreed value raises the need to strengthen the rationalization of management measures.This article aims to analyze the development of pharmaceutical services in the context of the primary health care (PHC) in the period 2008- 2014, focusing on selection, procurement and financing of medicines. A retrospective study was undertaken, using as data sources administrative documents of Rio de Janeiro Municipality Health Secretariat (SMS-RJ) as well as secondary database. We found a growth of numbers medicines offered for PHC of 57 items in 2008 to 222 in 2014. Actual spending on drugs paid by the city has grown 38% in the period, with a reversal from 2010, of the proportion of PHC related to tertiary care drugs, reaching 2.4 times in 2014, the year that public spending on medicines per capita of PHC was 9% greater than the value agreed between the three federal levels. It can be concluded that there have been important changes in pharmaceutical services in Rio de Janeiro Municipality in the period following the reform of PHC held in this territory, with increasing the conditions for therapeutic coverage and increased drug funding. The growth of per capita public spending on medicines above the agreed value raises the need to strengthen the rationalization of management measures.

Assistência Farmacêutica nos 30 anos do SUS na perspectiva da integralidade

This paper aims to analyse changes in the retail pharmaceutical market following policy changes in the Farmácia Popular Program (FP), a medicines subsidy program in Brazil. The retrospective longitudinal analyses focus on therapeutic class of agents acting on the renin-angiotensin system. Data obtained from QuintilesIMS (formerly IMS Health) included private retail pharmacy sales volume (pharmaceutical units) and sales values from 2002 to 2013. Analyses evaluated changes in market share following key FP policy changes. The therapeutic class was selected due to its relevance to hypertension treatment. Market share was analysed by therapeutic sub-classes and by individual company. Losartan as a single product accounted for the highest market share among angiotensin II antagonists. National companies had higher sales volume during the study period, while multinational companies had higher sales value. Changes in pharmaceutical market share coincided with the inclusion of specific products in the list of medicines covered by FP and with increases in or exemption from patient copayment.

Applying a health system perspective to the evolving Farmácia Popular medicines access programme in Brazil

Resumo Os autores analisam a Assistencia Farmaceutica (AF) e o acesso a medicamentos no Brasil na perspectiva do principio da integralidade nos 30 anos do SUS. A partir da sua inclusao no movimento de reforma sanitaria, foram selecionados temas relevantes, incluindo a reorientacao da AF, a questao de recursos humanos, o conceito de medicamentos essenciais, o uso apropriado de medicamentos, o desenvolvimento tecnologico e a producao industrial e a regulacao etica. Com fortes componentes regulatorios e tendo a politica nacional de medicamentos como eixo estruturante, as tres decadas do SUS sao confrontadas entre avancos e retrocessos, considerando a complexidade nacional, as mudancas politicas, economicas e sociais que impactaram politicas publicas e o acesso a medicamentos, tema que hoje mostra sua importância mesmo nas economias mais ricas do mundo, a partir de foros de discussao relacionados com Saude Global. As conquistas ao longo do tempo sao destacadas, considerando a preocupacao decorrente do regime fiscal que compromete as areas sociais.

Programa "Farmácia Popular do Brasil": caracterização e evolução entre 2004-2012

The Farmácia Popular Program (FPP) launched a subsidy system in Brazil, but in coexistence with the ongoing regular governmental access to medicines (Unified Health System (SUS) dispensings) mechanisms, causing overlaps in terms of financing and target population. This characteristic is quite different from most countries with medicines cost-sharing schemes. This paper aims to analyse the FPP under a health systems perspective considering the different health system levels. We analysed the findings from the study ‘Impact of consecutive subsidies policies on access to and use of medicines in Brazil – ISAUM-Br’, designed with the objective of describing and evaluating the impact of the government medicines subsidy policies implemented between 2004 and 2011. Patient share of copayment increased with the implementation of the intervention, which decreased the reference price and decreased with SNP (Saúde Não Tem Preço; zero copayment for patients). There was an increased number of FPP dispensations over time, but SUS dispensings remained the most important source for medicines, especially for hypertension and diabetes. FPP allowed the establishment of a well-designed pharmaceutical information system in the country. Despite the improvement on control mechanism, fraud remained a problem. There were important effects on the pharmaceutical market and sales of generic medicines. FPP has proven to be a very important policy for promoting access to medicines for hypertension and diabetes in Brazil. Examining this policy with a health system perspective has allowed us to highlight many of its important consequences, including for the first time a broad and consistent information system on access to medicines in the country.