THE National Supplementary Health Agency (ANS) included new procedures in the mandatory list for coverage of health insurance. The resolution published in this Thursday’s edition, 23, of the Official Diary of the Unionenters into force on October 22.
The following three procedures are included in the list: cerliponase alfa to treat neuronal ceroid lipofuscinosis type 2 (CLN2); intracerebroventricular implantation of drug infusion pump; and application of injectable hormonal contraceptives.
CLN2 is an “ultra-rare” disease and, in the classic form, affects children between 2 and 4 years of age, with irreversible degenerative evolution. In a February resolution, the National Commission for the Incorporation of Technologies in the SUS (Conitec) recommended not incorporating alpha-cerliponase into the Unified Health System. “Conitec members considered the clinical evidence adequate, considering the severity and rarity of the disease and the potential to change the natural course of the disease, but with a high cost-effectiveness ratio and budgetary impact.”
As for the use of contraceptives in women in the fertile period, coverage will be mandatory for the drugs medroxyprogesterone + estradiol cypionate and algestone acetophenide + estradiol enanthate. Both were unanimously recommended by Conitec for inclusion in the SUS at a meeting in April this year.
At the beginning of the month, the Second Section of the Superior Court of Justice (STJ) decided restrict the procedures offered by health plan operators in the country. The ministers defined that the nature of the ANS list is exhaustive, which exempts companies from covering medical requests that are outside the list.
If there is no therapeutic substitute or if the procedures on the list are exhausted, however, the STJ has defined that there may be exceptional coverage of the treatment indicated by the doctor or dentist. But, for this, it is necessary that: the incorporation of the procedure to the list has not been rejected by the ANS; there is proof of the effectiveness of the treatment in the light of medicine; there are recommendations from nationally and internationally renowned technical bodies, such as Conitec and Natjus; whenever possible, the inter-institutional dialogue of the magistrates with experts in the health area is carried out, without shifting the competence of the judgment of the case to the Federal Court.
The list consists of a list of “procedures considered essential for the diagnosis, treatment and monitoring of diseases and health events” that the country’s health care plans are required to offer – depending on the type of plan signed. The list is available on the agency’s website.