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f_0022083_18200 - "11 $-0)$343#$/01"2#3!4-5'3-46"0)1 With...

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!"# ! "#$""% ()*+, -%. / 01#*+" 2 # 3" ! 4-5*)*-% % -#*(%-) ()*+, (% 3-46-+"0#*+-)1 With around 190 million inhabitants, Brazil is one of the fastest growing pharmaceutical markets in the world. Annually, domestic pharmaceutical sales amount to approximately U.S. $15 billion and the country also imports an estimated U.S. $4 billion in pharmaceuticals (SINDUSFARMA 2010). The consumption of medicines is unequally distributed, with the richest 15 percent of the population consuming 48 percent, and the bottom 51 percent consuming only 16 percent (Dias 2006). To remedy this, the public healthcare system, Sistema Único de Saúde (SUS), provides medicines for free for those individuals who cannot afford them but have a medical prescription confirming their need. In 2007, SUS distributed more than 443 million free medicines throughout the country (DATASUS 2007). In recent years, Brazil has seen a dramatic increase in the number of individuals who attempt to procure access to medicines through judicial lawsuits. Lawsuits generally involve individuals who were eligible for free medicines but failed to obtain medicines through the public healthcare system, either because the required medication was not covered under public pharmaceutical distribution lists or because covered medicines were not dispensed in a timely and consistent manner. Courts, by and large, have tended to rule in favor of the plaintiffs and mandate the provision of treatment by the state. While the judiciary has an important role in guaranteeing access to medicines for the population in Brazil, its role in case-by-case treatment decisions may interfere with the implementation of state health policies. This paper explores the relationship between the state and the judiciary $%&’%(%*+’,-.-/-0%12$3432’5%6#!#7&%89%.+-:.;+$%5.+&’(*9<1’0*-1’0=>&-7&%? %. *&’(0+.-( @(’A+&5’.=B5 C--8&-D C’15-( /0;--1 -: *9<1’0 %(8 E(.+&(%.’-(%1 F::%’&5 %(8%?+?<+&-:.;+&+5+%&0;7&-9>-:.;+*&’(0+.-(G+%1.;H&%(8I;%11+(7+5E(’.’%.’A+3 /;+ 0%( <+ 0-(.%0.+8 %. ?%&’%(%35-0%1J7?%’130-?3 ()*+, " 11-, $%&’%(% *+’,-.- /-0%12 $343
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!"! in the provision of medicines in Brazil. It assesses strategies through which the state can improve efficiency in providing medicines and recommends that, in addition to guaranteeing individual rights, courts should also enforce the effective implementation of state health policies. !" $ %&’()’ *&+ % ,(-,!(. The Brazilian Unified Health System (UHS) was created under the country’s 1988 Constitution, which established health as a basic right and placed onus on the state to provide health care (Ribeiro 2009). The Organic Law of Health, 1 passed in 1990, identified pharmaceutical policies as one of the UHS responsibilities, though the government did not create a National Policy on Pharmaceuticals until 1998 (see Ministry of Health 1998). One of the core characteristics of the UHS is decentralized provision of health care. As such, the responsibility for the provision of medicines is divided between the federal, state, and municipal governments. The federal government is responsible for financing higher cost and higher complexity treatments (i.e. “exceptional medicines”); the state govern- ment provides intermediate cost and medium-complexity treatments (i.e.
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