Program of high cost medicines in the Brazilian health system, 2000-2004

Rationale: The Program of High Cost Medicines (PHCM) of the National Health System (SUS) in Brazil aims to respond to the demand for high unitary cost medicines or for drugs used in chronical diseases that imply in an overall high cost of treatment. Nowadays, one third of the federal resources invested in pharmaceutical products is aimed at high cost medicines.
Objectives: To describe drug profile use and assess the government expenditure of these drugs by the PHCM.
Methods: Patients under the PHCM, enrolled from 2000 to 2004, were identified in the Ministry of Health’s database. Socio-demographic characteristics, drug profile use and expenditures were investigated and described. The monthly expenses had been corrected by general index of inflation and updated to values of December 2006. For each year of follow-up, the individual average expenditure with high cost medicines was obtained dividing the total amount registered  by the number of monthly occurrences in the period.
Results: The number of people which received drugs for the first time by the PHCM was increased from 65.534 in 2000 to 144.535 in 2004.  Most of them were female (63,5%) and  30.6% were 60-years-old or more. The five most frequent drugs prescribed were: recombinant human erythropoietin (11.9%), Alendronate (10.9%), calcitriol (6.6%), calcitonin (4.7%), olanzapine (4.4%), The average monthly individual expenditure was USD 187.95 in the first year of follow-up and USD 187.02, USD 185.35, USD 181.10, USD 202.51 during the subsequent years. 
Conclusions:  The access to high cost medicines increased during the studied period. Global expenditures also increased, but little variation in the average monthly individual expenditure was observed across the follow-up. The analysis of drug use profile and expenditure with high cost medicines can contribute to a more equitable allocation of resources and to guarantee more rational access to high cost medicines in Brazil.