What is the maximum recovery value? Resolution 3056 of 2018 of MINSALUD
By: Diana González-Bravo
Resolution 3056 of 2018 defines the new methodology for calculating the maximum value for the recognition and payment of services and technologies not financed with the Capitation Payment Unit (UPC). This is a regulation of interest to the different actors in the health system, insofar as some of them are affected by its provisions. Below we present the main concepts contained in this resolution.
The Law 1753 of 2015 created the Administrator of the Resources of the General System of Social Security in Health (ADRES) in order to administer, protect and promote the efficiency of the economic resources of the health system and avoid undue, irrelevant payments or fraud in the system. In development of this purpose, the Ministry of Health and Social Protection issued the resolution 3056 of 2018 , which empowers the ADRES to obtain information and apply the methodology for calculating the maximum recovery value (VMR). This calculation will take into account a retrospective horizon of a maximum of two years (2 previous validity periods).
Below we will present the main points on which the VMR calculation methodology is based.
What is the Maximum Collection / Collection Value (VMR)?
It is the maximum value per unit that the ADRES must recognize and pay to the recovering entities for the services and technologies that are not financed with the UPC. In the case of medicines, these units correspond to the minimum unit of concentration (UMC) or the minimum unit of dispensing (DMU). The value of the UMC is established based on the contained amounts of active principle of the drugs to be recovered, without distinguishing presentations, concentrations or trade names. For its part, the UMD value is calculated based on the “drugs whose presentation is in combination of fixed doses (eg tablet)” (Step 3 of the technical annex, Resolution 3056 of 2018 ).
On the other hand, the resolution also establishes that all drugs in the same relevant group will have the same VMR. And what is a relevant group?
Relevant groups concept
A relevant group of drugs is the set of drugs that are part of the same therapeutic group, taking into account all their concentrations available on the market and in all pharmaceutical forms that have the same route of administration. These therapeutic groups are defined based on the Anatomical Therapeutic Chemical level 5 (ATC) classification.
Relevant groups are defined by the competent authority. However, in exceptional situations, ADRES may form these groups when:
- There are drugs with active ingredients of the same ATC level 4 or 5 with the same pharmaceutical form, with therapeutic equivalence and scientific evidence that supports it.
- There are active ingredients of ATC level 5 drugs if there is scientific evidence to support it.
VMR calculation methodology
The technical annex to the resolution sets out the methodology and technical guidelines for calculating VMR. This methodology is designed for drugs and consists of:
1. Identification of information sources required for the calculation of VMR. Such sources include: SII_MYD, SISMED, and INVIMA records.
2. Prioritization of the technologies for which the VMR will be calculated.
3. Calculation of the VMR, composed of 5 steps:
b. Identification of the CMU (mcg, mg, ml, IU) or UMD of each relevant group.
c. Calculation of VMR in UMC or UMD.
d. Outlier detection.
and. Final calculation of the VMR in the form of UMC or UMD.
When the calculation of the VMR is required, the ADRES will be the entity in charge of applying the calculation methodology. The result will be reported to the Ministry of Health and Social Protection in order to make official the list of relevant groups with their respective VMR, which will take effect from the moment of its publication.
The resolution makes the following special considerations for the calculation of VMR:
- The prices of medicines that have been set by the National Commission for the Prices of Medicines and Medical Devices (CNPMDM) will not be subject to this calculation. If the CNPMDM has established the maximum value of a drug, said price will be the VMR when applicable.
- ADRES will not recognize VMR for medications that do not have INVIMA approval or that are not part of the UNIRS list (uses not included in the sanitary registry).
- In the event that the recovering entities present recoveries for health services and technologies not financed with UPC resources with values lower than those defined by the VMR, the ADRES will pay the value established by said entities and not the VMR.
If you want more information, Neuroeconomix invites you to consult the complete document of the Resolution 3056 of 2018 (PDF download).
Topics that might interest you:
Republic of Colombia. Ministry of Health and Social Protection. Resolution 3056 of 2018. July 23 of 2018. Available at: https://www.minsalud.gov.co/Normatividad_Nuevo/Resoluci%C3%B3n%20No.%203056%20de%202018.pdf
Republic of Colombia. Law 1753 of 2015.
Republic of Colombia. Law 1753 of 2015.
Ministry of Health and Social Protection. Decree 433 of March 05, 2018.