Access to medications worth up to RD$16 million for high-cost illnesses ensured
Santo Domingo — Members with complex or catastrophic illnesses will have comprehensive access to essential treatments, costing RD$2 million to RD$16 million per patient per year.
Patients will have access to this benefit after the High Cost Medicines Fund (FOMAC) is approved, an initiative designed and promoted by the Superintendency of Health and Labor Risks (Sisalril).
FOMAC provides 100% coverage, with no co-payments or annual limits, for an initial catalog of 13 high-cost medications.
These drugs are Ribociclib, Palbociclib, Pembrolizumab, Adalimumab, Etanercept, Golimumab, Infliximab, Tocilizumab, Ustekinumab, Blinatumomab, PEG-Asparaginase, Octreotide and Risdiplam.
These therapies are intended for the treatment of breast cancer, lung cancer, and some types of childhood cancer, including acute lymphoblastic leukemia, Hodgkin lymphoma, retinoblastoma, Wilms tumor, low-grade glioma, and Burkitt disease.
It is also used for rheumatoid arthritis, psoriasis, Crohn’s disease, acromegaly, and spinal muscular atrophy.
During a press conference, the Minister of Public Health, Víctor Atallah, and the head of Sisalril, Miguel Ceara Hatton, explained that the initiative aims to improve health protection, guarantee the continuity of treatments and reduce out-of-pocket expenses for the affiliated population at the most vulnerable time of their lives.
Officials reported that FOMAC is projected to benefit about 6,447 members, including diagnosed and new cases.
The 13 medications covered by the Family Health Insurance (SFS) are expected to help decongest the Ministry of Public Health’s High Cost Medication Program, which currently serves 8,468 patients and has 4,950 people on the waiting list.
The National Social Security Council (CNSS) recently approved FOMAC, and it will be financed with resources from the SFS, without increasing costs for workers and their direct dependents or imposing extraordinary contributions on employers.
The initiative has the support of the main associations of patients with complex and catastrophic diseases, whose representatives served on the working groups organized by Sisalril.
Centralized purchasing
FOMAC will enable centralized medicine purchases, taking advantage of volume pricing and economies of scale, a mechanism that would reduce system costs by approximately RD$6 billion.
FOMAC is expected to become operational within a maximum of one year, to allow time for capitalization and operational preparation.
Sisalril will supervise FOMAC’s implementation, in accordance with its regulatory and supervisory powers under the Dominican Social Security System (SDSS).
