Brazilian pharma: Increasing access to healthcare
Why the Health Has No Price program
is good news for the most vulnerable populations in Brazil
In
March, the Brazilian Health Minister, Alexandre Padilha, officially launched
one of the most important initiatives in terms of access to drugs since the
negotiations under the TRIPS agreement to bring down prices of HIV/AIDS drugs were
carried out at the beginning of the past decade.
The
initiative, an extension of the successful state program Farmacia
Popular do Brasil (Popular Pharmacies), consisted of a national campaign
for the free distribution of medicines for hypertensive and diabetic patients,
called Sade No Tem
Preo (Health Has No Price).
In
practical terms, this means that such drugs can be obtained without cost in
private or public pharmacies enrolled in the Aqui Tem Farmcia Popular strategy,
an extended network of public and private pharmacies.
Throughout
Brazil, there are 15,000 pharmacies that are part of this agreement to sell
drugs under the government subsidy scheme.
In
addition to patients with these illnesses, the Pharmacia Popular scheme offers
drugs for treating chronic conditions such as asthma, rhinitis, Parkinson's
disease, osteoporosis, and glaucoma.
The
government's budget for the Health Has No Price program is $280 million
annually.
In
fact, the President of Brazil, Dilma Rousseff, made the program one of her
pledges during the presidential campaign as part of a strategy focused on
tackling extreme poverty in Brazil.
According
to estimates from the Ministry of Health, approximately 960,000 hypertensive
and diabetics patients should benefit from the measure.
Indeed,
free medicines will be available to all Brazilians who have a doctor's
prescription, but the authorities say they expect the offer to be taken up
mainly by poorer people who use the public health system. (For more on Brazil,
see Breaking
into the Brazilian pharma market'.)
Access for all
However,
it is worth noting that this announcement is an extension of policies, such as
Farmacia Popular, which are already being implemented.
Since
2004, 107 drugs, including hypertension and diabetes treatments, have been
heavily subsidized by the government through this network of pharmacies, with a
90% discount in price. Vulnerable patients had to pay only 10% of the price of
the drug.
Under
the new Sade No Tem Preo scheme, only hypertension and diabetes treatments
will be provided free and there will be a list of drugs available in each
pharmacy specifying which drugs can be obtained without cost, mainly generics.
Why
is it so important in a country like Brazil to increase the subsidy from 90% to
100% for diabetes and hypertension drugs?
Because
an important part of the Brazilian population, projected to be over 200 million
people in 2011, still suffers from inadequate access to healthcare, reflecting
deep-seated and long-standing socioeconomic inequalities common to Latin
American countries.
Despite
the huge increase in funds directed to the Unified Healthcare System (SUS), a
national health service that aims to provide health services on a universal and
equitable basis, in practice around 50% of the country's population is believed
to lack systematic access to medical care.
The
middle and upper classes-with the ability to pay-take out private health
insurance, which gives them access to better quality medical facilities and
shorter waiting times.
However,
according to WHO data (2008), the percentage of out-of-pocket expenditure in
the private sector is 51.8%.
It
is important to raise the alarm that diabetes and hypertension are the leading
causes of mortality in the country, with 49.8 male deaths and 47.9 female
deaths per 100,000 habitants (2008).
Changing
lifestyles have influenced a demographic transformation and a growing incidence
of noncommunicable diseases.
This
has been evident in all segments of the population, including children and
adolescents.
What
has not been so well distributed is the capacity of patients to get access to treatment,
which is why it's important to focus benefits such as eliminating co-payment in
diabetes and hypertension treatments.
As
you might think, the drugs included in Farmacias Popular program and Sade No
Tem Preo are generics and, in some cases, are not the most up to date
treatments.
However,
withdrawing barriers such as out-of-pocket spending in the context of sensible
long-term treatments is definitely good news for the most vulnerable population
of Brazil.
Ruben
Gennero is a healthcare and pharma Latin American markets analyst with IHS
Global Insight. For his take on the vaccine market, see Mapping
the Latin American vaccine market'.
For
more on Latin American markets, join the sector's other key players Sales & Marketing Excellence
Brazil on June 15-16 in So Paulo.
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