Division of Thoracic Surgery - Department of Surgery, University of Massachusetts Medical School, 67 Belmont street, Worcester, MA, 01605, USA.
Pharmaceutical Policy Research Fellowship, Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Drive Suite 401, Boston, MA, 02215, USA.
BMC Public Health. 2020 Jan 8;20(1):24. doi: 10.1186/s12889-019-8095-0.
Increasing medicines availability and affordability is a key goal of Brazilian health policies. "Farmácia Popular" (FP) Program is one of the government's key strategies to achieve this goal. Under FP, antihypertension (HTN) and antiglycemic (DM) medicines have been provided at subsidized prices in private retail settings since 2006, and free of charge since 2011. We aim to assess the impact of sequential changes in FP benefits on patient affordability and government expenditures for HTN and DM treatment under the FP, and examine their implications for public financing mechanisms and program sustainability.
Longitudinal, retrospective study using interrupted time series to analyze: HTN and DM treatment coverage; total and per capita expenditure; percentage paid by MoH; and patient cost sharing. Analyzes were conducted in the dispensing database of the FP program (from 2006 to 2012).
FP has increased its coverage over time; by December 2012 FP covered on average 13% of DM and 11.5% of HTN utilization, a growth of over 600 and 1500%, respectively. The overall cost per treatment to the MoH declined from R$36.43 (R$ = reais, the Brazilian currency) to 18.74 for HTN and from R$33.07to R$15.05 for DM over the period analyzed, representing a reduction in per capita cost greater than 50%. The amount paid by patients for the medicines covered increased over time until 2011, but then declined to zero. We estimate that to treat all patients in need for HTN and DM in 2012 under FP, the Government would need to expend 97% of the total medicines budget.
FP rapidly increased its coverage in terms of both program reach and proportion of cost subsidized during the period analyzed. Costs of individual HTN and DM treatments in FP were reduced after 2011 for both patients (free) and government (better negotiated prices). However, overall FP expenditures by MoH increased due to markedly increased utilization. The FP is sustainable as a complementary policy but cannot feasibly substitute for the distribution of medicines by the SUS.
提高药品的可及性和可负担性是巴西卫生政策的一个关键目标。“平价药房”（FP）计划是政府实现这一目标的关键策略之一。自 2006 年以来，FP 计划以补贴价格向私人零售药店提供降压（HTN）和降血糖（DM）药物，自 2011 年以来则免费提供。我们旨在评估 FP 福利的连续变化对 HTN 和 DM 治疗的患者负担能力和政府支出的影响，并研究其对公共融资机制和计划可持续性的影响。
采用纵向、回顾性研究，使用中断时间序列分析：HTN 和 DM 治疗覆盖率；总支出和人均支出；卫生部支付的百分比；以及患者自付费用。分析在 FP 计划的配药数据库中进行（2006 年至 2012 年）。
FP 随着时间的推移扩大了其覆盖范围；截至 2012 年 12 月，FP 平均覆盖了 13%的 DM 和 11.5%的 HTN 使用率，分别增长了 600%和 1500%以上。MoH 每例治疗的总成本从 2006 年的 36.43 雷亚尔（巴西货币）降至 2012 年的 18.74 雷亚尔，DM 的成本从 33.07 雷亚尔降至 15.05 雷亚尔，人均成本减少了 50%以上。患者自付的药品费用随着时间的推移而增加，直到 2011 年，但随后降至零。我们估计，要在 2012 年根据 FP 为所有需要 HTN 和 DM 治疗的患者提供治疗，政府将需要支出药品总预算的 97%。
在分析期间，FP 无论是在计划覆盖面还是在成本补贴比例方面都迅速扩大。自 2011 年以来，FP 中个体 HTN 和 DM 治疗的成本对患者（免费）和政府（更好的谈判价格）都有所降低。然而，由于利用率显著增加，MoH 的 FP 总支出增加。FP 作为一种补充政策是可持续的，但不能替代 SUS 分配药品。
