MP that forces health plan to provide oral chemotherapy goes to sanction

The Chamber of Deputies approved this Thursday (10) the provisional measure that obliges health plans to provide oral chemotherapy at home, two days after Congress maintained President Jair Bolsonaro’s (PL) veto of a bill that brought similar device.

If it were not voted on this Thursday, the provisional measure, approved in the Senate on Wednesday night (9), would lose its validity. In the Chamber, deputies accepted part of the senators’ amendments in a symbolic vote. Now, the text goes to Bolsonaro’s sanction.

Before the discussion of the MP, the president of the Chamber, Arthur Lira (PP-AL), praised the report made by deputy Silvia Cristina (PDT-RO), also responsible for the opinion of the project vetoed by Bolsonaro, and said that the deputies got it right. uphold the presidential veto.

“I am also sure that this House, for the most part, was right to maintain the veto so that we, who started the construction of this matter in the provisional measure, with some changes by the Senate, can ratify the text that will produce, I have no doubt, in the lives of people who need these drugs,” he said.

The original interim measure sent by the federal government did not contain a requirement for plans to provide oral chemotherapy. The text brings new rules for supplementary health, such as deadlines for the incorporation of new treatment technologies in the private network.

The device on oral chemotherapy was included during the proceedings in the Chamber of Deputies and maintained by the senators.

The text gives ten days, after the medical prescription, for plans to offer oral antineoplastic treatment directly to the cancer patient or a legal representative. This can occur through the plan’s own network, accredited, contracted or referenced.

The plans also need to prove that the patient, or his representative, has received guidance on the use, conservation and eventual disposal of the drug.

The deputy partially maintained the amendments made by the senators. She accepted the provision that increased to 180 days, extendable for another 90 days, the deadline for completing the evaluation process for incorporating new technologies into the list of supplementary health procedures.

In the case of oral chemotherapy, Silvia Cristina kept the deadline of 120 days for the administrative process. However, it rejected the part of the amendment that established the hypothesis of rejection of the incorporation when the product is approved by Conitec (National Commission for Incorporation of Technologies in the Unified Health System), but is unavailable to health service providers or if there is another impediment relevant.

“This measure would open up the possibility that the ANS [Agência Nacional de Saúde Suplementar] reject the incorporation of products already approved within the scope of the Unified Health System, based on a highly subjective criterion of ‘another relevant impediment'”, wrote the deputy in her opinion.

Silvia Cristina also rejected another amendment made by the Senate and which prohibited readjustments outside the term of the health plan law 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 for something, because before it, the government with absolutely all the time in the world did nothing for people with cancer,” he said.

For the veto to fall, it had to be rejected by both legislative houses. The Senate overrode the veto, but the House maintained it. In the session, deputy Claudio Cajado (PP-BA), guided by the government and defended the maintenance of the veto, arguing that “the provisional measure is more comprehensive and much better to meet the assumptions of the matter that is under deliberation.”

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.

In a note distributed this Thursday, FenaSaúde (National Federation of Supplementary Health) evaluated that the text will definitively guarantee “the reduction in the deadlines for incorporation of new technologies in the list of ANS, for the benefit of millions of patients”.

The federation stated that, by matching the ANS deadlines with those of Conitec, “the measure guarantees faster access to quality medicines by health plan users – a process that is currently supported by strict technical criteria”.