The Senate approved this Wednesday (9) a provisional measure that forces health plans to provide home treatments for oral use against cancer, the so-called oral chemotherapy.
The approval comes a day after the National Congress upheld President Jair Bolsonaro’s (PL) veto of another bill, which barred the same measure.
It would be necessary for the House and Senate to have an absolute majority of votes in each House to override the veto. This happened in the Senate, but federal deputies upheld the presidential decision.
The other proposal, the provisional measure, was approved this Wednesday by the senators in a symbolic way. However, there was a change in the text and, therefore, it will need to go through a new vote in the Chamber of Deputies. Deputies will need to consider the measure urgently, as the MP expires this Thursday (10).
The interim measure sent by the federal government did not initially contain a proposal to compel plans to provide oral chemotherapy. The text deals with new rules for supplementary health, such as deadlines for the incorporation of new treatment technologies in the private network. However, the measure was included during its processing in the Chamber of Deputies and the senators kept this item.
The text of the MP provides for a period of ten days, after the medical prescription, for the plans to offer directly to the cancer patient or to a legal representative the home antineoplastic treatment for oral use – oral chemotherapy. This supply can take place through the plan’s own network, accredited, contracted or referenced.
The plans also need to prove that the patient, or his/her representative, has received proper guidance on the use, conservation and eventual disposal of the drug.
The rapporteur of the provisional measure in the Senate, Daniella Ribeiro (PP-PB), promoted changes in relation to the text approved by the federal deputies, so the proposal will need to return to the Chamber.
The proposal initially provided for a period of 120 days, extendable for another 60 days, for the conclusion of the evaluation process for the incorporation of new technologies into the list of procedures and events in supplementary health.
The senator accepted an amendment that increases this period to 180 days, extendable for another 90. The rapporteur argued that this period is reasonable, which is the same period adopted by Conitec, the commission that analyzes the incorporation of new technologies into the SUS (Unified Health System). ).
However, the senator only kept the original deadline for the incorporation of technologies in the scope of oral chemotherapy.
If the ANS (National Supplementary Health Agency) does not present a decision by the deadline, the drug or procedure will be automatically included in the list until there is a definition.
Another amendment accepted by the rapporteur, authored by Senator Humberto Costa (PT-PE), prohibits readjustments were the term of the health plan law, which are to balance contracts as a result of technological incorporations to the list of procedures.
​The text creates the Commission for Updating the List of Procedures and Events in Supplementary Health, which will be responsible for advising the ANS. The body will be composed of a representative appointed by the CFM (Federal Council of Medicine) and a representative of the medical specialty society, according to the therapeutic area or the use of technology to be analyzed, indicated by the AMB (Brazilian Medical Association).
The requirement for health plans to pay for oral chemotherapy treatments and the presidential veto provoked a great reaction in Congress and in society. The proposal had been unanimously approved in the Senate and later with a large margin of votes in the Chamber of Deputies.
The author of the bill, Senator Reguffe (Podemos-DF), harshly criticized President Jair Bolsonaro for the veto.
“First it amazes me that the bill was useful for something, because before it, the government with absolutely all the time in the world did nothing for people with cancer,” he said.
“The provisional measure reduces the time for the ANS to judge, but it maintains the ANS approval. Now, the patient already has to wait for Anvisa’s approval, which sometimes takes a while. Sometimes, there are new drugs in the United States that have already been approved by the regulatory agency, and he has to wait for Anvisa’s approval. Then it takes Anvisa approval and, when he approves Anvisa, he will still have to wait for ANS’ approval. The right thing would be to withdraw the ANS, as it is today in the intravenous. intravenous, just Anvisa approves and the health plan has to pay”, he added.
The deputy leader of the government Carlos Viana (MDB-MG), in turn, pointed to the existence of the “judicialization of health”. The parliamentarian explained that many drugs are still being tested abroad, but that judges without training issue decisions in favor of these drugs, causing great impact for health operators.
By vetoing the text, the federal government argued that, if it came into force, the measure would have a financial impact on the private plan market and this would result in an increase in the amounts paid by policyholders.
When the bill was approved, the National Federation of Supplemental Health upheld the presidential veto, saying the decision was appropriate for patient safety.
The entity, which concentrates the giants of the sector, argues that the automatic inclusion foreseen in the project would harm the “sustainability of a system that assists more than 48 million people”.
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