Update of the PBS Health Benefits Plan for 2020, what changed?
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With the publication of the Resolution 3512 of 2019 The list of drugs, procedures and services that must be financed with resources from the Capitation Payment Unit (PBS-UPC) is updated. But what is this health benefits plan? How many changes have there been since your last update? How is it different from the old Mandatory Health Plan (POS)?
In this post we will talk about the update of the Health Benefits Plan (PBS 2020) and how many changes there have been since its last version.
What is the PBSUPC? Why should it be updated?
Because health is considered a right in Colombia, all citizens must have access to health services. Consequently, the system has as a mechanism to guarantee access to these services an assurance scheme. This assurance scheme is called collective protection mechanism.
Because the resources for insurance are limited, for this mechanism to be financially sustainable, it is necessary to establish which are the most important health services and technologies to satisfy the needs of the population. This makes it possible to ensure that there are resources to finance them. This type of list is known as a benefit plan, benefit package or basket of services (1). In Colombia, this set of benefits is called the Health Benefits Plan charged to the Capitation Payment Unit (PBSUPC), replacing the Mandatory Health Plan (POS) since 2016.
Due to the fact that the diseases that affect the Colombian population are changing and new health technologies are developed, it is necessary that this set of benefits be updated periodically. According to current legislation, the Health Benefits Plan Charged to the Capitation Payment Unit (PBSUPC) must be updated every year. The PBSUPC was updated in 2018 by the Resolution 5857 of 2018 and more recently by the Resolution 3512 of 2019, which defines the benefits that will be part of this set during 2020.
What changed with the last update?
Changes in the Health Benefits Plan charged to the Capitation Payment Unit (PBSUPC) generated by the Resolution 3512 of 2019 were less significant than those of the previous update (Resolution 5857 of 2018). Among the most relevant changes is the addition of a requirement for the provision of telemedicine services. This requirement establishes that for telemedicine services to be covered with UPC resources, they must be provided in accordance with the parameters for their practice established in the Resolution 2654 of 2019. Also, in the Resolution 3512 In article 38, some clarifications were added about some drugs that can be considered implicitly financed with UPC resources.
What drugs can be considered implicitly financed with UPC resources?
When a molecule is explicitly included in the PBSUPC in the form of a racemic mixture (a mixture of compounds with the same chemical structure but different spatial orientation, that is, with more than one stereoisomer), it can be assumed that drugs that include only one stereoisomer are they can finance with UPC resources as long as they have the same indication. For example, because ibuprofen (a racemic mixture of two stereoisomers) is included in the PBSUPC, it is assumed that dexibuprofen (one of its stereoisomers) would also be covered by the UPC.
However, in the Resolution 3512 it is clarified that, if only one stereoisomer is included in the drug list, the racemic mixture of this molecule is not necessarily financed. In our example, if dexibuprofen is included in the UPC's resource-funded list of drugs, it cannot be assumed that ibuprofen is as well.
On the other hand, it was clarified that, although the drugs that contain the active metabolite of a precursor explicitly included in the list of drugs are also considered financed with resources from the UPC. This funding applies only in the sense of precursor to active metabolite and not vice versa. For example, risperidone - indicated in the treatment of schizophrenia - is a precursor to paliperidone, so it can be assumed that, if risperidone is funded, so will paliperidone.
Another important clarification that was added is that a drug used for an indication on the UNIRS list (Uses Not Included in the Health Registry) cannot be financed with UPC resources. This regardless of whether it is included in the benefit plan for other indications.
New drugs and procedures included in the PBSUPC
Last year in the Resolution 5857 of 2018 62 new drugs, 13 procedures and 40 clinical laboratory procedures were added to the set of benefits. In contrast, in the Resolution 3512, which updated the PBS for this year, only two new procedures (partial thyroid ablation and partial parathyroid ablation) and a new antibiotic (sultamicillin) were added.
Although these drugs were already in the PBSUPC, the levonorgestrel code corresponding to its indication as emergency contraceptive was added to the drug list. Likewise, the code corresponding to the use of sodium phosphate as an enema was included and the codes corresponding to tenofovir in the form of tenofovir alafenamide (in monotherapy and in combination with emtricitabine) were added.
Likewise, in the annexes of the resolution a section was added in which it is made explicit that the drugs used during anesthesia, analgesia and sedation; radiopharmaceuticals; solutions and diluents; As well as the different substances and medicines for nutrition, they are financed with resources from the UPC. However, these were already part of the PBSUPC according to the Resolution 5857.
In resolution 3512 of 2019, a section was added in the annexes where it was made explicit that anesthetics, analgesics, sedatives, peripheral action muscle relaxants and reversers of anesthesia and sedation, when considered necessary and irreplaceable, are financed with resources from the UPC. However, this still leads to ambiguities regarding the financing of these drugs, because it is necessary to assess whether or not the drug used is necessary and irreplaceable.
There are the same type of ambiguities regarding the financing of fixed-dose combinations of active principles of drugs included in the list; Master forms; radiopharmaceuticals; solutions and substances for nutrition.
These types of inaccuracies lead to disputes about the financing of technologies and services between different actors in the system. This is due to the fact that they allow different interpretations of the possible sources of financing, causing a lack of clarity in the accounts. This was evidenced, for example, in the enormous differences between the accounts presented by the Health Promoting Entities, the Health Provider Institutions and the State in the end-point agreement in which it was sought to settle the accumulated debts in the health system (watch: https://www.neuroeconomix.com/de-que-se-trata-el-acuerdo-de-punto-final/).
In addition, the lack of clarity in the sources of financing of benefits can lead to administrative barriers and delays in care that compromise people's health (2). It is for this reason that, although there have been countless advances regarding the Health Benefits Plan charged to the UPC, it is necessary that in the next updates the financing of the benefits included in the aforementioned categories becomes more evident.
In the following links you can download the technical annexes in Excel of Resolution 3512 of 2019.
To see the blog about the POS 2019 enter HERE
1. Rovira J, Rodríguez-Monguió R, Antoñanzas F. Health benefit packages: objectives, design and application [Internet]. Washington, DC: World Health Organization; 2003 [cited 2019 Jan 24].
2. Keliddar I, Mosadeghrad AM, Jafari-Sirizi M. Rationing in health systems: A critical review. Med J Islam Repub Iran. 2017 Aug 27; 31: 47.