In 2017, in a scenario of financial restrictions caused by an economic crisis in Brazil, a new primary health care policy promoted changes in the way different primary health care models were prioritized and implemented, with possible negative effects on the access to primary health care. This study aims to investigate if the 2017 Brazilian National Primary Care Policy (PNAB) negatively affected the primary care organization based on the Family Health Strategy (FHS) model and on the access to public primary care services in the city of Rio de Janeiro. The annual averages and the pre- and post-2017 averages of 15 variables were analyzed to identify possible trend breaks in 2017. A Bayesian structural time series model was used to determine the differences between actual and predicted post-2017 averages of each variable. The data were obtained via the Brazilian Health Informatics Department (DATASUS), the Department of Informatics of the Brazilian Unified National Health System. The annual average of family health teams was 1,179.9 teams, in 2017, and 788.8 teams in 2020, while the annual average of equivalent family health teams was 163.6, in 2017, and 125.4, in 2020. The actual post-2017 average of 989.3 family health teams (p = 0.004) was 16.7% lower than the predicted post-2017 average of 1,187.4 teams. In total, 62.6% and 40.5% of the population in Rio de Janeiro were covered by the FHS in 2017, and 2020, respectively. The provision of public primary care services decreased after 2017. Results show a deterioration of the FHS in Rio de Janeiro after 2017 and no increase in the traditional primary care model. Access to public primary care services reduced in the same period.

The United States (US) is the largest economy in the world and the largest pharmaceutical market, accounting for 40% of the global expenditure on pharmaceuticals and almost half of the global pharmaceutical pipeline. This review describes prescription drug regulation, pricing and coverage in the US and provides perspectives for policy reform. With an unregulated market-based pricing system for drugs, the US pays on average 3 to 4 times higher prices for branded prescription drugs than other industrialized countries. Challenges posed by rising drug prices create affordability problems that threaten the American population’s health as well as the sustainability of the US healthcare system. The US stands out as the country with the highest health expenditure per capita, at about 17% of its gross domestic product, and with pharmaceuticals representing over 12% of the total health expenditure. Health coverage is strongly dependent on employmentbased private insurance, with government programs like Medicare and Medicaid providing coverage to older and poorer populations, respectively. Coverage for outpatient prescription drugs is included in most, if not all, private health insurance plans and government programs. Although some drug pricing policy reforms have been proposed in recent years, no major nationwide initiatives have been successful in the US thus far. High drug prices might not only impact the US care system’s efficiency, but can also have a ripple effect to other countries like Brazil that use the US for external reference pricing, even if those countries may have other price regulation mechanisms in place. This is particularly important for new therapies for which no other international prices may be available in the global market besides the one from the US. The growing budgetary pressures from rising drug prices underscore the need for US drug pricing reform and highlight the need for global pricing mechanisms that can help ensure early access to new technologies at fairer prices.