Increasing Access to Oral Anticancer Medicines in Middle-Income Countries: A Case Study of Private Health Insurance Coverage in Brazil.

The World Health Organization estimates that approximately 60% of the world's new annual cancer cases occur in Asia, Africa, and Central and South America, and that 70% of cancer deaths occur in these regions. Although oral chemotherapy is a promising intervention for cancer treatment, given its high cost, it is usually unavailable in middle-income countries. In 2013, after strong lobbying from civil society, Brazil's Congress passed legislation mandating that all private health insurance companies provide access to oral antineoplastic treatment. The decision to scale up the provision of oral chemotherapy was a watershed event in the regulation of private health insurance in Brazil. Until then, private insurers, which cover 25% of the population, were exempted from the provision of pharmaceutical drugs for home care treatments. This article explores the political process involved in regulating the provision of oral chemotherapy medicines by private health insurers. Elements of this successful advocacy case included investment in strategic communication, specialized knowledge of regulatory policy, and the ability to act via democratic channels of political representation. In turn, the receptiveness of government branches such as the Congress and regulating bodies, as well as the Cancer Awareness Month campaign, opened a window of opportunity. However, prospects for expanded access to such medicines in the public health system are bleak in the short term because of the ongoing political and economic crisis.
Competing Interests: Authors' disclosures of potential conflicts of interest and contributions are found at the end of this article.Increasing Access to Oral Anticancer Medicines in Middle-Income Countries: A Case Study of Private Health Insurance Coverage in BrazilThe following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or jco.ascopubs.org/site/ifc.Elize Massard da FonsecaNo relationship to discloseFrancisco Inácio BastosNo relationship to discloseGilberto LopesHonoraria: AstraZeneca, Roche/Genentech, Merck Serono, Merck Sharp & Dohme, Fresenius Kabi, Novartis, Bristol-Myers Squibb, Janssen-Cilag Consulting or Advisory Role: Pfizer, Bristol-Myers Squibb, Lilly/ImClone Research Funding: Lilly/ImClone, Pfizer, AstraZeneca, Merck Sharp & Dohme, Eisai Expert Testimony: Sanofi Board Member: Instituto Oncoguia scientific board