ANS includes three procedures in health insurance coverage

The Official Journal of the Union this Thursday (23/6) brought the inclusion of three procedures in the list of the National Health Agency (ANS). Only treatments included in the document are required to be covered by health plans.

These are: therapy with cerliponase alfa for type 2 neural ceroid lipofuscinosis (CLN 2), intracerebroventricular implantation of a drug infusion pump, and application of an injectable hormonal contraceptive.

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New procedures added to the ANS list by Metropoles on Scribd

CLN2 is a very rare disease with a genetic mutation, extremely serious and with early mortality, due to the deficiency of tripeptidyl-peptidase 1. In general, it affects children between 2 and 4 years old with irreversible degenerative evolution.

Death occurs between age 10 and early adolescence. Before, the child has epileptic seizures, speech delay and motor impairments. Thus, the alpha-cerliponase would delay the effects of evil.

The intracerebroventricular implantation of a drug infusion pump is a form of drug application, including cerliponase alfa itself.

Finally, the application of injectable hormonal contraceptives enters as an official contraceptive method that must be covered by the plans. Now, the drugs medroxyprogesterone + estradiol cypionate and algestone acetophenide + estradiol enanthate also enter.

Judicial decision

On June 8, the Superior Court of Justice (STJ) decided that the list of ANS procedures would be exhaustive. In other words, the coverage of health plans is restricted only to procedures provided for in an already defined list.

On the other hand, the exemplary list would facilitate charging health plans for new techniques or innovative procedures that emerge with the evolution of medicine. In other words, a taxing list makes it difficult to charge health plans for extra treatments.

Before, if a patient needed a procedure that was not on the list, he would have to go to court. In general, magistrates understood that the list was exemplary and gave the appellant a win.

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