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Plan de beneficios en salud 2021

Update of the Health Benefits Plan for 2021, what changed?

Ornella Moreno

Ornella Moreno Mattar
Health Administrator,
MSc in Public Policy,
health economics lead

Through Resolution 2481 of 2020, the Ministry of Health and Social Protection has updated the Health Benefits Plan charged to the Capitation Payment Unit - PBSUPC. This update defines all the technologies that make up the PBSUPC as of January 1, 2021

Why is this update being done?

In accordance with article 25 of Law 1438 of 2011, the competent administrative authority must update the Health Benefits Plan Charged to the Capitation Payment Unit -PBSUPC integrally every two years in attention to changes in the epidemiological profile and burden of the disease of the population, availability of resources, balance and extraordinary medications not explicit within the Benefit Plan (1).

 

Decree 2562 of 2012, in article 2, establishes that the competent administrative authority to update the PBSUPC is the Ministry of Health and Social Protection, and that this institution must “define and review, at least once a year, the list of essential and generic drugs that will be part of the Benefit Plans ”(2). With the issuance of this regulation, the Ministry of Health has published since 2013 the annual update of the Benefit Plan through normative acts (See table 1).

 

PBS 2021

Source: Ministry of Health and Social Protection website:
https://www.minsalud.gov.co/salud/POS/Paginas/plan-obligatorio-de-salud-pos.aspx

 

In compliance with these regulations, on December 24, 2020, the Ministry of Health issued Resolution 2481 of 2020 "By which health services and technologies financed with resources from the Capitation Payment Unit (UPC) are fully updated" (3), which entered into force on January 1, 2021.

 

What changes with this update and what remains the same?

Within the content of the norm, paragraph 5 of article 25 was included, which refers to the period of hospitalization, stating that "Prolonged hospitalization will not be financed from UPC resources when it is for care other than health," be it a social absence or a social abandonment ”.

 

Additionally, article 56 no longer refers only to the prescription of drugs in accordance with the Clinical Practice Guidelines but with Good Prescribing Practices.

 

Regarding the structure of the annexes, since 2018 the PBS update resolutions have three technical annexes that are classified as follows:

 

  • Annex 1 "List of drugs financed with UPC resources"
    • Section A1. Financing with UPC resources per medicine.
    • Section A2. Financing with UPC resources for medicines by reference subgroups.
    • Section A3. Financing with UPC resources for medicines with specific criteria.
    • Section B. Drugs for special programs in public health.
    • Section C. Financing with UPC resources for other products.

 

  • Annex 2 "List of health procedures financed with UPC resources"

 

  • Annex 3 "List of clinical laboratory procedures financed with UPC resources"

 

Sections A3, B and C of Annex 1 did not have adjustments in the update for the year 2021 (Resolution 2481 of 2020) in relation to the previous regulations. Sections A1, A2 of Annex 1, as well as Annexes 2 and 3 if they had changes.

 

What are the new drugs and procedures included?

This update of the PBSUPC for 2021 has a particular precedent, during 2020 the administrative route of payments for non-PBS medicines was restructured, including the Maximum Budgets in the health sector scenario.

 

This antecedent is important because, according to the Ministry of Health, during 2020 of all the medicines recognized in the country with public resources, the 61% were financed with the UPC and the remaining 39% with Maximum Budgets. With the update for 2021, the 73% of these drugs will be financed with UPC and the other 27% with Maximum Budgets, thus facilitating the interaction between providers and insurers (4).

 

Among the changes for each annex are:

 

Annex 1. List of medicines financed with UPC resources (SECTION A1):

This section is the most extensive as it includes 498 medicines financed by the UPC (36 more than in the previous year), among which were included medicines for indications such as type II diabetes mellitus, rheumatoid arthritis, psoriatic arthritis, breast cancer , prostate, endometriosis and uterine myoma.

 

Within the adjustments, conditional uses were also eliminated in 55 medicines and new pharmaceutical forms were included for 45 medicines, allowing its use in other populations, for example, pilocarpine, which had an exception in pharmaceutical forms for oral use, is now in all strengths and dosage forms.

 

On this section, the technical annex provides four clarifications:

to. Medicines with the active principles, concentrations and pharmaceutical forms described in this section are included in the collective protection mechanism and are financed with resources from the Capitation Payment Unit (UPC).

b. Medicines not explicitly described are also financed with UPC resources if they comply with the provisions of article 129 of this administrative act.

c. Medications where clarifications are not made are financed with UPC resources in all indications authorized by INVIMA according to article 40 of this administrative act.

d. If an active principle is not explicitly found in section A1, it must be taken into account that it may be financed and described in the financing with UPC resources in another section of annex 1 or described in the articles of this administrative act

 

Annex 1. List of medicines financed with UPC resources (SECTION A2):

In this section, 18 reference subgroups listed below were included:

  • A10BD - oral hypoglycemic drug combinations
  • A10BJ - Type 1 glucagon-like peptide analogues for the treatment of type 2 diabetes mellitus
  • A12CB - Zinc
  • B03AD - iron in combination with folic acid
  • C01DA - organic nitrates
  • C03EB - high ceiling diuretics and potassium sparing agents
  • C07AG - alpha and beta-blocking agents
  • C08GA - calcium channel blockers and diuretics
  • C09BA - ACE inhibitors and diuretics
  • G03XC - selective estrogen receptor modulators
  • H01AA - ACTH
  • J01CR - penicillin combinations, incl. Beta-lactamase inhibitors
  • L02BA -antiestrogens
  • N03AB - hydantoin derivatives
  • N03AG - derivatives of fatty acids
  • N05AX - other antipsychotics
  • N06AB - selective serotonin reuptake inhibitors
  • P01AC - derivatives of dichloroacetamide.

 

Annex 2. List of health procedures financed with UPC resources:

Procedures such as vulvar or perineal repairs, tissue elasticity studies, esophageal manometries, and allergy immunization were included in this annex.

 

Annex 3. List of clinical laboratory procedures financed with UPC resources:

The update for 2021 included new procedures such as the measurement of antiplatelet (specific), the semi-automated or automated toxoplasma IgG antibody avidity test, BRCA1 and BRCA2 complete sequencing, and finally BRCA1 and BRCA2 known familial mutation.

 

Despite these new inclusions and advances in the expansion of the PBSUPC, conditions continue to be presented for some drugs, for example, Fixed Dose Combinations (Art. 41) are only financed with the UPC when the following two conditions are met simultaneously: i) all the active ingredients that are part of the drug are contained in the list in Annex 1 and ii) the cost of treatment with the combined drug is equal to or less than the sum of the cost of each of the drugs, if used as monopharmaceuticals separately.

 

The above and other cases such as radiopharmaceuticals (Art 49), which are only financed with the UPC "when they are necessary and irreplaceable", may continue to represent barriers to recognition and agreements between providers and insurers.

 

In the following links you can download the technical annexes in Excel of Resolution 2481 of 2020.

 

Medications POS 2021

PBS 2021 Procedures

PBS 2021 Laboratory Procedures

 

To see the blog about POS 2020 enter HERE

 


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References

1. Congress of the Republic of Colombia. Law 1438 of 2011. Colombia; 2011.

2. Presidency of the Republic of Colombia. Decree 2562 of December 10, 2012. 2012. p. 10.

3. Ministry of Health and Social Protection of Colombia. Resolution number 0002481 of December 24, 2020. 2020.

4. Ministry of Health and Social Protection of Colombia. Health Benefits Plan is updated under the charge of the UPC. Press Bulletin No 1064 of 2020. 2020 Dec 30;

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