OBJECTIVE: To describe the relationship between the prescribing physician, lawyer and pharmaceutical industry in lawsuits against the state. METHODS:Retrospective descriptive study based on data from administrative fi les, relating to lawsuits involving medicine demands, in the State of Minas Gerais, from October 1999 to October 2009. The variables studied were: gender, age, benefi ciaries' illness, type of medical care (public or private), prescriber, type of legal representation and requested medication. A descriptive analysis of the variables with the distribution of frequencies was carried out. RESULTS:A total of 2,412 lawsuits were analyzed with 2,880 medicine requests, including 18 different drugs, 12 of them provided through Pharmaceutical Policies of the Brazilian National Health System (SUS). The most frequent medicines requested were adalimumab, etanercept, infl iximab, insulin glargine and tiotropium bromide. The main diseases were rheumatoid arthritis, ankylosing spondylitis, diabetes mellitus and chronic obstructive pulmonary disease. Private lawyers and doctors were predominant. The results revealed the association between doctors and law offi ces on drug requests. Among the lawsuits fi led by the offi ce A, 43.6% had a single prescriber of adalimumab, while 29 doctors were responsible for 40.2% of the same drug prescriptions. A single doctor was responsible for 16.5% of the adalimumab prescriptions, being requested through lawsuits fi led by a single private law offi ce in 44.8% of legal proceedings. CONCLUSIONS:A greater representation of doctors and lawyers from the private sector can hinder equity in health. The results revealed the association between doctors and law offi ces on drug requests. This is an indication that justice and medical practice have been used, at certain times, to serve the interests of the pharmaceutical industry. DESCRIPTORS:Health lawsuits and access to health . Equity in health. Pharmaceutical industry. Incorporation of medicines. Lawsuit offi cials. Doctors.

OBJECTIVE To investigate the factors related to the granting of preliminary court orders [injunctions] in drug litigations.METHODS A retrospective descriptive study of drug lawsuits in the State of Minas Gerais, Southeastern Brazil, was conducted from October 1999 to 2009. The database consists of 6,112 lawsuits, out of which 6,044 had motions for injunctions and 5,167 included the requisition of drugs. Those with more than one beneficiary were excluded, which totaled 5,072 examined suits. The variables for complete, partial, and suppressed motions were treated as dependent and assessed in relation to those that were independent – lawsuits (year, type, legal representation, defendant, court in which it was filed, adjudication time), drugs (level five of the anatomical therapeutic chemical classification), and diseases (chapter of the International Classification of Diseases). Statistical analyses were performed using the Chi-square test.RESULTS Out of the 5,072 lawsuits with injunctions, 4,184 (82.5%) had the injunctions granted. Granting varied from 95.8% of the total lawsuits in 2004 to 76.9% in 2008. Where there was legal representation, granting exceeded 80.0% and in lawsuits without representation, it did not exceed 66.9%. In public civil actions (89.1%), granting was higher relative to ordinary lawsuits (82.8%) and injunctions (80.1%). Federal courts granted only 68.6% of the injunctions, while the state courts granted 84.8%. Diseases of the digestive system and neoplasms received up to 87.0% in granting, while diseases of the nervous system, mental and behavioral disorders, and diseases of the skin and subcutaneous tissue received granting below 78.6% and showed a high proportion of suspended injunctions (10.9%). Injunctions involving paroxetine, somatropin, and ferrous sulfate drugs were all granted, while less than 54.0% of those involving escitalopram, sodium diclofenac, and nortriptyline were granted.CONCLUSIONS There are significant differences in the granting of injunctions, depending on the procedural and clinical variances. Important trends in the pattern of judicial action were observed, particularly, in the reduced granting [of injunctions] over the period.

This paper analyzes the possible interference of the pharmaceutical industry in prescriptions drugs used in lawsuits against the Brazilian National Health System (SUS). It presents the survey used to build the database with lawsuits by drugs, procedures and equipment for the treatment of various diseases against the State of Minas Gerais. It is the analysis of the perception of the prescribers in order to know their respective positions in relation to the theme of the interference of the pharmaceutical industry in decisionmaking relating to lawsuits. The theoretical model and methodology used highlights the profile of the interviewees. Finally, it exposes in detail the analysis of the perceptions of prescribers, correlating them with the topic of the influence of the pharmaceutical industry in the current growth of lawsuits.

Introduction: Biological medicines have increased the cost of cancer treatment and has raised sustainability concerns. In Brazil, three monoclonal antibodies (MABs): bevacizumab (BEVA), cetuximab (CETUX) and panitumumab (PANIT), are indicated for the treatment of metastatic colorectal cancer (mCRC) but currently not currently funded by the Unified Health System (SUS). However, they have been funded following successful litigation cases. Objective: Evaluate the budget impact of BEVA, CETUX and PANIT MABs if they became part of standard chemotherapy to treat mCRC within the SUS of Minas Gerais (MG), in Brazil. Method: Budget impact analysis incorporating MABs as first-line treatment of mCRC in MG/Brazil was explored. The Brazilian health system -SUS perspective was adopted and a 5-year time horizon was applied. Data from the lawsuits from January 2009 to December 2016 were collected and the model was populated based national databases and published sources. Costs are expressed in USD. Results: 351 court lawsuits were granted for first-line MAB treatment for mCRC. In three alternative scenarios analyzed there was an increase in costs, which ranged from 348 to 395% compared to the reference scenario. PANIT presented a $103,360,980 budget impact compared to the reference scenario over a 5-year time horizon. BEVA and CETUX presented a $111,334,890 and $113,772,870 budget impact, respectively. Considering the restrictions on the use of MABs Anti EGFR (CETUX and PANIT) in patients with about 41% KRAS mutations, the best cost alternative adopted for incorporation should be the combination of the PANIT and BEVA antibodies, which demonstrated a cost of approximately $106 million. Conclusion: These results highlight the appreciable costs for incorporating BEVA, CETUX and PANIT into the SUS. It is likely appreciable discounts will be needed to permit incorporation.

Resumo Este trabalho investiga a participação do Sistema de Justiça no processo de efetivação do direito à saúde por meio do confronto de dois caminhos para a atuação judicial. De um lado, a forma predominante, marcada pela individualização das demandas, pela incapacidade de alcançar as falhas políticas que determinam a extensão da oferta de prestações em saúde e pelo potencial de desorganizar o Sistema Único de Saúde (SUS). De outro, uma perspectiva estrutural de atuação que aproxima a intervenção judicial dos conflitos determinantes para a consolidação e sustentabilidade do sistema público de saúde. A partir da análise de pedidos judiciais para acessar os fármacos ranibizumabe e bevacizumabe em Minas Gerais, investiga-se a mudança de cenário esperada no caso de uma atuação judicial estrutural pelo Supremo Tribunal Federal no tratamento das Ações Diretas de Inconstitucionalidade nº 4.234/DF e 5.529/DF. Os resultados apontam para a importância de o Sistema de Justiça privilegiar uma perspectiva estrutural. No atual contexto, marcado por ataques cada vez mais explícitos ao direito à saúde, é fundamental que o Sistema de Justiça participe do processo de efetivação do SUS de forma mais coerente e consciente dos conflitos que definem as possibilidades de construção de um sistema público universal. A crise econômica, o agravamento do subfinanciamento da saúde (em especial devido à Emenda Constitucional nº 95/2016) e o preço insustentável dos novos medicamentos - implicando sua crescente participação na totalidade dos gastos em saúde - apontam para a necessidade de que questões estruturais alcancem centralidade na judicialização da saúde.