High-Cost Medicines in Brazil: Challenges to Ensuring Access

Abstract

Access to medicines is not limited to their availability but also involves their appropriate and continuous use, including access to the necessary information and services. This study explored aspects related to treatment follow-up among users of the Specialized Component of Pharmaceutical Assistance (CEAF), considering the recommendations established in the Clinical Protocols and Therapeutic Guidelines (PCDT). This was an observational, descriptive, and analytical study. Data on medication use and access to monitoring tests recommended in the PCDT were collected. Two groups were purposively selected, considering treatment characteristics and different levels of healthcare complexity: respiratory and rheumatological diseases. Data were collected from July 2021 to December 2022. Among patients with respiratory diseases (n = 185), 77.8% had problems with adherence to inhaler devices; 26.0% were active smokers; 34.6% had frequent contact with smokers; 28.7% had undergone spirometry in the previous 2 years; 69.7% reported disease-related symptoms; 31.9% reported complaints related to adverse drug reactions (ADRs); and 30.8% reported doubts and/or difficulties regarding treatment. Among patients with rheumatological disease, 30.8% used 3 or more medications for the condition; 59.7% reported symptoms; 37.3% reported complaints related to ADRs; 30.4% had undergone ESR and CRP testing in the previous six months; 42.2% had moderately or severely limited functional capacity; and 35% reported doubts about treatment. The results suggest that effective access requires conditions for the appropriate, safe, and continuous use of medicines, together with monitoring of treatment outcomes. Integrated studies addressing the different dimensions of access are needed to support the improvement of CEAF.