Resolution 3934/2024 limits the prescription of high-cost medications to doctors from closed health plans, in order to protect the sustainability of the health system in Argentina. (Illustrative Image Infobae)
Argentina limits prescriptions for high-cost medications in closed health plans
- The Resolution 3934/2024 affects the issuance of prescriptions in closed plans.
- Members must go to licensed doctors for high-cost prescriptions.
- The measure seeks system sustainability and reduce unnecessary expenses.
The essential: In a recent statement, the Superintendence of Health Services of Argentina clarified the scope of the Resolution 3934/2024which restricts the issuance of prescriptions for high-cost medications in closed health plans. The regulations require that patients go exclusively to doctors on their social work record to obtain this type of prescription, avoiding reimbursement in the case of outpatient consultations. According to the superintendent Gabriel Oriolothe objective is to preserve financial sustainability and reduce the judicialization of cases, limiting prescription to specialists who know the patient’s history.
The Superintendency of Health Services clarified that Resolution 3934/2024 “does not represent any modification in the medications, treatments or medical care of the vast majority of Argentines.”
Why it matters: This measure impacts the beneficiaries of closed plans, since:
- It affects access to expensive treatments and serious diseases.
- Seeks to reduce conflicts of interest and unnecessary expenses.
The regulations of the Superintendency of Health Services in Argentina seek to ensure that high-cost medications are prescribed responsibly, protecting the resources of the health system. (Illustrative Image Infobae)
After the recent Resolution 3934/2024 issued by the Superintendence of Health Services in Argentina, which limits the issuance of prescriptions for high-cost drugs and treatments in closed health plansthe national entity issued a statement in which it warned that “It does not represent any modification in the medications, treatments or medical care of the vast majority of Argentines who use the Health System.”.
In this sense, they highlighted that the rule “will be expanded in the coming days, mentioning the set of diseases defined as high-priced or catastrophic, among which are serious oncological diseases, rare diseases, transplants, spinal muscular atrophy, ALS, fibrocystic disease, among others. This change, according to the superintendent’s argument Gabriel Oriolo, responds to the need to preserve the sustainability of the system, avoiding high-cost prescriptions that are not always necessary or appropriate.
In that tone, the statement released on social networks assures that “they are called high-priced, or also catastrophic because it refers to a set of diseases whose cure or treatment implies a high economic cost, generating severe damage to the health of those who suffer from it. and its financing from the household budget is unsustainable.”
“In this way, what this measure seeks to ensure is the right of the beneficiaries to access treatments, practices or medications for these pathologies and that they are duly authorized by the Health Insurance Agents to guarantee their quality of care,” they emphasized.
Resolution 3934/2024 establishes that beneficiaries of closed health plans must resort exclusively to licensed doctors to access high-cost medications. (Illustrative Image Infobae)
The resolution mainly affects beneficiaries of closed health plans, who from now on must go exclusively to doctors included in the social work or prepaid card to obtain prescriptions for high-cost medications. This provision implies thatif the member consults a professional outside the authorized network, they will not be able to access the reimbursement option for that prescription, a situation that marks a significant change in the way high-value treatments are managed.
From the Superintendence of Health Servicesfor their part, argued that this approach seeks to reduce the costs of prescriptions outside the doctor’s network, since many of them usually come from professionals who are not familiar with the patient’s medical history, which can lead to treatments more expensive or even unnecessary. In this sense, the superintendent Gabriel Oriolo He stressed, in radio statements: “We want to ensure that the system’s resources are allocated efficiently and equitably, since this compromises the sustainability of the system itself.”
In contrast, those with open plans will be able to continue with the flexibility of consulting outside the card, either for reasons of trust in long-established doctors or for recommendations from specialists outside their network. In addition, these members may receive reimbursements for these consultations, since the regulations exclude this type of coverage so that beneficiaries maintain their right to choose between various providers without having to assume the high costs of complex treatment.
The measure seeks to ensure, they argued, that expensive medications are only prescribed to those who really need them, protecting the sustainability of the health system. (Illustrative Image Infobae)
“Prepaid medicine companies that offer open plans allow the patient to see a provider not included in the card and offer refunds on those consultations,” Oriolo pointed out, and reiterated that “this regulation does not apply to open plans, only to closed plans, where the beneficiary has a broad list of providers that they must access.”
Regarding this difference, Superintendent Oriolo had highlighted that the regulations “do not seek to limit access to regular or lower-cost treatments” for members of closed plans. The main purpose, indicated the national official, is to ensure that high-priced medications, especially those that are critical for serious illnesses, are prescribed by professionals who know in detail the patient’s clinical history, “thus protecting the efficiency of the system.” and avoiding unnecessary expenses that could compromise its sustainability over time.
The Resolution 3934/2024 Its central objective is to preserve the financial sustainability of Health Insurance Agents. According to Oriolo, the regulations respond to the need to prevent “doctors who do not know the patient’s medical history from prescribing high-cost drugs” without due specialization in the pathology, which could generate a negative impact on the system’s resources. Furthermore, the Superintendency explained that the measure attempts to reduce the judicialization which families often incur to obtain coverage for expensive or experimental medications, which in some cases do not have sufficient scientific support.
The official explained that “those medications that are high priced and that in some cases are even experimental or do not even have scientific evidence, certain doctors prescribe them and are not specialists.” “We are not looking for the traditional, habitual or chronic medicine that patients require be regulated in some way,” he assured. At the same time, he indicated that it is intended for “those who have rare or catastrophic diseases so that they receive high-priced medications.” “adequate.”
For this reason, the resolution includes the obligation for the doctors involved to sign a sworn declarationwhich seeks to avoid possible conflicts of interest with pharmaceutical laboratories. Finally, Oriolo insisted that “we want specialists, and not a doctor with little experience, to prescribe these medications.”
