ANS must force health plans to cover rapid Covid test

The ANS (National Supplementary Health Agency) must approve this Wednesday (19) the inclusion of rapid antigen tests for Covid in the list of mandatory procedures of health plans.

The obligation for operators to cover this type of exam has been discussed since June, with resistance from operators and criticism of the agency for the delay in incorporating the technology.

Currently, health plans are required to cover only the RT-PCR test, whose result takes an average of 48 hours to come out, and the antibody test, which reveals whether the person has been sick in the past — and was only included in the list. after court decision. Antigen tests, on the other hand, give results in 15 minutes and, therefore, are considered essential to contain the spread of the coronavirus.

The requirement was approved on Tuesday (18) by Cosaúde (Commission for Updating the List of Procedures and Events in Supplementary Health) of the ANS and must be confirmed by the collegiate board of the body at an extraordinary meeting scheduled for 18:00 this Wednesday.

The commission anticipated in one day the discussion on rapid tests at the request of the ANS board itself, which has been the target of pressure due to the outbreak of the ômicron variant. “There is an urgency to discuss the matter”, said yesterday the general manager of Assistance Regulation of the ANS and coordinator of Cosaúde, Ana Cristina Martins.

There is still a need to define the rules for using the service, the so-called DUT (Use Guideline), which will be discussed throughout this Wednesday by the technical area of ​​the ANS and presented during the board meeting.

But, according to what was agreed yesterday in the commission, the rapid tests should be covered by operators only for patients with symptoms between the 1st and 7th day and who have requested a doctor (as is the case today for the RT-PCR exam, gold standard diagnosis of coronavirus).

Although celebrated, the commission’s decision arrived late, in the assessment of the vice president of the Brazilian Society of Clinical Pathology and Laboratory Medicine (SBPC/ML), Alvaro Pulchinelli. “This meeting was supposed to take place last month, and today we are in the middle of the omicron storm. We are always discussing a step back from the pandemic”, he said.

Lawyer Ana Navarrete, from Idec (Brazilian Institute for Consumer Protection), also criticizes the seven-month analysis. For her, one of the explanations for the delay was the pressure from operators not to incorporate new technologies.

The president of Abramge (Brazilian Association of Health Plans), Renato Casarotti, says that the plans are not against incorporation, but that it is necessary to create rules so that unnecessary tests are not carried out. He also says that the delay in Cosaúde’s decision did not harm the customers or generate access restriction. “No one was left untested,” he says.

This Tuesday’s meeting was the first for Cosaúde, formed by the agency’s technical staff, business associations and members of civil society, which advises and makes recommendations to ANS.

The commission was created in November amid new measures to speed up work on including new procedures. The mandatory coverage list has only been updated every two years since 1998.

With the pandemic and the pressure to incorporate new treatments and services, a new resolution from the agency in July defined its update every six months.

Sought, the ANS said that it started in June, in an extraordinary way, the discussion on the inclusion of the rapid test in the coverage of the plans and that since then it has been following the standard rite of evaluation. “During this period, we considered the decrease in the number of cases, the expansion of vaccination coverage for different age groups, in addition to meetings with representatives of the supplementary health sector to discuss the issue”, says the agency, in a note.

According to ANS, the uncertain scenario of the pandemic required new strategies to gather information more quickly about new technologies and their financial impacts on supplementary health, in case of inclusion in the list (see the complete position).

Carrier resistance

The inclusion of the antigen test faces resistance from operators since the beginning of the debates. Companies say they fear the irrational and exaggerated performance of tests and therefore ask for restrictions on supply. “The problem is that the person does two, three, four tests in the same week. From a clinical point of view this makes no sense”, says Casarotti, from Abramge.

“We are not in favor of this exam being incorporated precisely because we understand that it will be an additional test and not a substitute”, said the representative of Fenasaúde, another association of the sector, during the first meeting that discussed the subject, in July. The companies’ fear is that patients will undergo an antigen test and, in case of a negative result, also undergo an RT-PCR test in the same week of symptoms.

Fenasaúde changed its position this Tuesday and approved the inclusion of the exam in the list of procedures, but endorsed a proposal presented by Unimed do Brasil —corroborated by all the health plan associations present at the meeting— which restricts the offer.

The company has suggested that antigen testing be offered only when RT-PCR is unavailable, a proposal that has met with criticism. “I don’t understand why Unimed finds it convenient to take the most expensive test first, instead of the most affordable test, with a faster result” said doctor Norma Rubini, scientific director of the Brazilian Association of Allergy and Immunology (Asbai).

Unimed’s proposal should not be accepted by the ANS, as indicated by the general manager Ana Cristina Martins. “I don’t think it’s reasonable, because it could be that in one city there’s an exam and in another there’s the other”.

Health plans also cite the current shortage of tests to justify stricter rules of use.

Another point of contention in the debate was regarding the interval between each test. The associations of the plans advocate that the exam be vetoed even for people with flu symptoms when they received a positive result in the previous 90 days.

For Rubini, from Asbai, it is a very long term, as people are being reinfected.

All agreed that health plans will not pay for testing asymptomatic patients or those who have had recent contact with people who have become infected.

The so-called contact tracing is not the responsibility of supplementary health – it should be a public policy led by the Ministry of Health, but it faces serious implementation problems. THE Reporter Brazil revealed this week that the ministry failed to acquire these tests and canceled the purchase of 14 million exams, which jeopardized the mass testing plan, scheduled to start in September, but which never took off.