Access to high-cost medications for psoriatic arthritis in the National Health System in Brazil: the long path up to dispensation

Abstract

Background: Pharmaceutical Assistance (PA) is a dynamic and multidisciplinary process that aims to supply health systems, programs or services with quality medicines, enabling access and health care, in an efficient and timely manner. The objective of the study was to evaluate the profile of administrative processes for the treatment of PsA, identify the time elapsed in the flow of processes and its associated factors. Methods: A cross-sectional study of medication requests for the treatment of PsA was carried out between November 2014 and December 2016. Linear regression was used to verify the factors associated with time to delivery. Results: A total of 218 cases containing 250 drugs were analyzed. The median time between the medical appointment and the first dispensation was 66 days (interquartile range, 44-90). The State proceedings, which includes requesting the drug until the authorization of treatment, was the stage that most contributed to the total time spent. The factors associated with the longer time to delivery of medications were prescriptions coming from clinics and specialty centers, from dermatologists, non-authorized processes and non-persistent patients in the treatment in 12 months. Conclusion: The median time to receive medicines for the PsA treatment in Belo Horizonte health region after a medical prescription was higher than 2 months. The time between the solicitation of the medicines and the authorization of the treatment in the SUS (State administrative procedure) was the main component of the total time spent.

Medication adherence and persistence of psoriatic arthritis patients treated with biological therapy in a specialty pharmacy in Brazil: a prospective observational study

“…4,5 On another hand, an effort has been made to improve the quality of pharmaceutical services, including the expansion of drugs offer. 6 In 2009, the Minas Gerais State, one out of 27 Brazilian states, reorganized the public pharmacies investing in four axes: a) human resources: improving the pharmacists' salaries and contract technical professionals; b) physical structure: construction of new pharmacies with better installations and pharmacist' office; c) information: development of information systems to manage pharmaceutical services; d) education: improve the qualification of pharmacists and other professionals of pharmacies. This reorganized was called "Rede Farmácia de Minas", a network of community public pharmacies placed in the municipalities of the State.…”

“…These pharmacies cover a health administrative region, which comprises a list of municipalities and a defined population. 6 PsA is a chronic immune-mediated inflammatory disease characterized by peripheral arthritis, enthesitis, dactylitis, as well as axial, skin, and nail involvement. [9][10] PsA must be properly diagnosed and treated to help minimize its impacts on patients' health.…”

“… 4 , 5 On another hand, an effort has been made to improve the quality of pharmaceutical services, including the expansion of drugs offer. 6 …”

“…These pharmacies cover a health administrative region, which comprises a list of municipalities and a defined population. 6 …”

The dispensation of drugs in the primary health care of the Single Health System/ Dispensação de medicamentos na atenção primária do Sistema Único de Saúde

“…(3) Nas últimas décadas, tem sido observada uma tendência de mudança no exercício da prática farmacêutica, que afasta-se de um modelo focado apenas no fornecimento de medicamentos e direciona-se para a compreensão das necessidades e atendimento dos pacientes, passando do papel de fabricante e fornecedor de produtos farmacêuticos para o de fornecedor de serviços, informações e assistência aos usuários dos serviços de saúde. (4) Neste contexto, a Política Nacional de Assistência Farmacêutica, parte integrante da Política Nacional de Saúde, envolve um conjunto de ações voltadas à pesquisa, desenvolvimento, produção, seleção, programação, aquisição, distribuição, dispensação e avaliação da qualidade dos produtos e serviços, com o intuito de contribuir de maneira determinante para a melhoria da qualidade de vida da população, tanto no âmbito individual como coletivo. (5) A constante evolução e o aprimoramento da Atenção Primária à Saúde (APS) têm refletido de maneira importante na assistência farmacêutica, visando melhorar a cobertura populacional e a compreensão sobre a necessidade do uso racional de medicamentos.…”