Judicialization of medicines in João Pessoa, PB, Brazil

Abstract

In the Brazilian Health System framework, there are several ways to guarantee therapeutic integrality, highlighting the existence of public health policies that assure the access to medicines, their rational use, their safety, effectiveness, quality, and financing. However, in some situations, access to medicines is not fully guaranteed for specific less frequent treatments, and to surety the right to health, the population increasingly uses judicial mechanisms. The objective of this work was to analyze the drug lawsuits filed against the municipality of João Pessoa-PB (2010 to 2020). The printed files were analyzed, accounting for 1,273 lawsuits made available by the Municipal Health Department. These data were organized by exploring the variables: the temporality of the judicial request, existence or not of a guardianship request, medicines requested, description of pharmaceutical characteristics, sex of requesters, and origin of medical care. The estimated cost of the actions in the period studied, based only on the cost of medicines from the Medicines Market Regulation Chamber (Anvisa) table, was R$41,948,469.44, with the year 2019 being the one with the highest expenditure. The most judicialized drugs were Lucentis® (Ranibizumab), Clexane® (Enoxaparin Sodium), and Xarelto® (Rivaroxaban), while the most expensive were Spiranza® (Nusinersena), Imbruvica® (Ibrutinib) and Ilaris® (Canakinumab). The demand for access to medicines by judicial means burdens the financial contribution destined to municipal pharmaceutical assistance, where expenses tend to increase due to the unpredictability of programming the acquisition, negatively impacting the public health of the studied municipality. Mechanisms must be created to help the Judiciary make decisions involving access to medicines.