Judicialização de medicamentos no SUS entre 2016 e 2018 em um município da Região Sul do Brasil

Abstract

The Federal Constitution of 1988 recognized and enshrined the right to health as a fundamental right status to be guaranteed by the State to people. Regarding this understanding, lawsuits demanding medicines being filed and becoming common, especially for the supply of medicines across the country as a guarantee of access. The present research aims to analyze the characteristics of the causes of medicines via judicialization in public health in a municipality in the Southern Region of Brazil, in the years 2016, 2017 and 2018. The study corresponds to a quantitative descriptive-exploratory research. The general profile of the demands was established through the total analysis of the processes related to the request for medicines filed by residents from the city of the study. From the reading of the lawsuits, the data provided were extracted and tabulated in a previously structured spreadsheet and subsequently underwent descriptive analysis. A total of 181 cases were included, 93.9% (171) against the state of Paraná and 6.1% (11) against the municipality of the study between 2016 and 2018, revealing a greater female profile of authors against the state and male against the municipality. The most prevalent underlying diseases of the authors were those of the eye and adnexa against the state, while against the municipality were those of mental and behavioral disorders. As for the legal characteristics of the actions, the Public Ministry represents 72.3% (123) of the plaintiffs, free legal assistance and the injunction request occurred in 100% (181) of the cases, and the injunction granted in 95.5% (171). 9.9% (18) of the cases were discontinued and the appeals also occurred in 9.9% of the cases. The average time to complete the process was 13 months, with no difference between city and state. The time for granting medication was shorter in the state, showing an average of 24 days, while in lawsuits against the municipality it was 54 days. The value of the lawsuits ranged from R$ 180.00 to R$ 551,632.60, with the state's average spending being considerably higher than the municipality's average. The most prevalent groups of medicines varied between actions against the state and municipality, with the state being the group of sensory organs 24.2% (44) and antineoplastic and immunomodulating agents 15.9% (29), and in the municipality nervous system 27, 3% (3) and alimentary tract and metabolism 27.3% (3). Of the total number of medicines, 96.7% (175) were prescribed by public services, requested by the active ingredient in 92.2% (178) of the cases; in addition, 92.3% (167) were not included in the drug formularies. It was concluded that over the analyzed period there was a gradual increase in the number of lawsuits, with a much higher number of lawsuits against the state, in addition to dissociations between the characteristics of the lawsuits filed against the municipality and the state, especially in relation to high-cost drugs under state’s responsibility. The assumption of the right to health guaranteed by the State differs from the situation evidenced, since the seeking for administrative and judicial means to obtain free medicines still exists in a representative and growing number, reflecting points of failure in access to medicines by the population in this scenario. The prescriptions gave by professionals in the public health system, in high demand for medicines not included in the drug formularies, reflect the difficulty that the strategy of the drug formularies has to keep up with the growing demand for updates and new medicines available worldwide. In this scenario, the Judiciary, when appealed, has adopted a concrete interpretation of the rights established by the current Federal Constitution, in order to enforce the foundations of the Democratic State of Law, as well as the fundamental objectives of the Republic, especially the right to health. For this reason, the judicial way, although slow, has been an alternative in the seeking for the immediate guarantee of the right in practice.