Health plans are now required to cover liver transplants

The board of directors of the ANS (National Supplementary Health Agency) approved this Friday (30) the inclusion of liver transplantation in its basic reference list. Thus, health plans are now required to cover the procedure.

The regulation, which should be published in the Official Gazette of the Union next Monday (3), applies to the treatment of patients with liver disease who are covered with the availability of the organ by the SUS single line.

To ensure coverage of procedures related to transplantation, the outpatient clinical follow-up and the period of hospitalization of the patient, as well as tests for quantitative PCR detection of cytomegalovirus and Epstein Barr virus, were included in the list of covered procedures.

The inclusion of transplantation in the list was carried out at the meeting of Cosaúde (Standing Committee for Regulation of Health Care), which was attended by representatives of the Ministry of Health and the National Transplantation Center.

The ANS also approved the inclusion of five other drugs in the list. The main one is Regorafenib, for the treatment of patients with advanced or metastatic colorectal cancer.

“Both technologies met the requirements set out in the standard and went through the entire evaluation and incorporation process after being presented through FormRol, the agency’s ongoing evaluation process, whose analysis is based on HTA (health technology assessment), system of excellence that strives for evidence-based health. They were also discussed in technical meetings of Cosaúde, held between June and September, and had wide social participation, through Public Consultation nº 100/2022”, informed the ANS, in a note.

The other four drugs, according to the agency, “are antifungals that can be used under an outpatient injection regimen and that make it possible to dehospitalize patients in a context of an increase in severe deep mycoses as a result of the Covid-19 pandemic.”

Are they:

• Voriconazole, for patients with invasive aspergillosis;
• Liposomal amphotericin B, for the treatment of rhino-orbito-cerebral mucormycosis;
• Isavuconazole, for treatment in patients with mucormycosis; and
• Anidulafungin, for the treatment of candidemia and other forms of invasive candidiasis.

In 2022 alone, the ANS has already made 13 updates to its list, with 12 procedures and 25 medications, in addition to important expansions for patients with global development disorders, such as Autism Spectrum Disorder (ASD).

On September 21, President Jair Bolsonaro (PL) sanctioned the bill that obliges health plans to pay for treatments that are not on the ANS list. The proposal ended the so-called exhaustive list and reestablished the exemplary list by determining that the agency’s list of procedures serves only as a reference for health plans — and does not mean that the items contained in the document are the only ones that must be covered.

In July, the agency had already ended the limits for consultations and sessions of psychology, speech therapy, occupational therapy and physiotherapy, provided that under medical indication.