ANS evaluates incorporating 18 health services into the list of plans

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The Collegiate Board of the National Supplementary Health Agency (ANS) evaluates authorization for 18 requests for items such as exams, treatments and medicines that are not yet on the list covered by health plans.

The analysis takes place after the decision of the Superior Court of Justice (STJ), this June, which considered the role to be exhaustive. In other words, it obliges the cost of only the items included in it and consolidates a new jurisprudence on the subject. Since then, entities have moved to ask for the expansion of the list of procedures covered by the plans.

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After the STJ’s decision, the ANS Board has already approved the inclusion of treatments for global developmental disorders, such as autism, Asperger’s and Rett’s Syndrome, drugs for degenerative diseases and the application of injectable contraceptives, for example. Currently, the list has more than 3,360 items.

In the assessment of Shirley Morales, the national health counselor and deputy coordinator of the Intersectoral Committee on Supplementary Health (Ciss) of the National Health Council (CNS), the inclusion of items after the decision of the STJ should be broadly evaluated.

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“We knew there would be moves in this direction. But this can undermine society’s understanding as a whole of the gravity of the STJ’s decision. This restriction makes it impossible for treatments for new diseases that may arise, as was the case with Covid-19, when you needed a diagnostic test, for example.”, he points out.

“As much as there is this expansion, which is very important for these groups that are mobilizing, we have people with rare diseases who are not able to mobilize in the same way”.

One of the groups that shows concern about the taxing role is the National LGBTI+ Alliance. THE CNN , the entity stated that the STJ’s decision has “the potential to harm trans people who need procedures that are more complex and modern every day”. In a note, the institution highlighted that it is concerned about the delay by the ANS to include these techniques.

The Alliance also stressed that surgeries for trans people should not be seen as aesthetic and that they hope that the scope of the role will be reversed by the STF or by law passed in Congress. Currently, surgeries such as neovagina, neophalloplasty, hysterectomy, mastectomy, are already on the list.

The Brazilian Institute for Consumer Protection (Idec) filed a lawsuit in the Federal Supreme Court (STF) against the resolution that provides for the list of health plan procedures as binding. He also participates in other lawsuits as an interested party or friend of the court, but which have yet to go to trial.

Idec recommends that a patient with a medical indication, who is denied treatment, should seek the right to care in court. In addition, it recommends that it be investigated whether the case meets any of the conditions set by the STF, such as:

– Inclusion of the service in the list has not been expressly denied by ANS;
– Treatment/medication is effective and has proven results;
– Be recommended by renowned national technical bodies, such as CONITEC and NATJUS, or by foreign ones;
– Judiciary seeks, when possible, information from technical bodies, without this representing a change in the progress of the process to the Federal Justice.

THE CNN sought out the Brazilian Association of Health Plans (Abramge) to ask for a position on how it sees the movement against the taxing role and the possibility of clients feeling harmed by the refusal of treatments. Our report awaits a response.

Since the STJ’s decision, ANS has approved the incorporation of the following items into the list:

– Coverage of any method or technique indicated by the attending physician for the treatment of the patient who has one of the pervasive developmental disorders, such as autism and Asperger syndrome.

– Cerliponase alfa drug, for the treatment of patients with neuronal ceroid lipofuscinosis (group of neurodegenerative diseases) type 2.

– Procedure for implantation of the device necessary for the administration of the drug cerliponase alfa (intracerebroventricular implantation of drug infusion pump).

– Application of injectable hormonal contraceptive (medroxyprogesterone acetate + estradiol cypionate and algestrone acetophenide + estradiol enanthate), for women of childbearing age.

Source: CNN Brasil

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