Ecuador: Patients Under National Insurance Plan Complain on Access to Medicines

CONSTITUTION OF ECUADOR –
Article 50.- The State shall guarantee to every person suffering from catastrophic or highly complex diseases the right to specialized and free care at all levels, in a timely and preferential manner.

The demands of patients do not guarantee timely access to medicines

eluniverso.com (machine translated) In hospitals like the IESS, in Machala, there have been complaints about the non-delivery of medicines in a timely manner.

The Ombudsman’s Office has intervened in eight cases, since 2016, in which the right to health of individuals has been violated by the State.

Every dawn without pain and with the energy of leaving the bed is a new opportunity to return to life for those suffering from catastrophic illnesses. It was for Audrey, Walter, Andrea , who died this year with metastatic cancer. The three members of the IESS met in the struggle to access treatments that include expensive molecules that are not in the basic table of medicines of the Ministry of Public Health (MSP). It is a list with more than 700 drugs that applies to the IESS – an autonomous entity that draws on the contributions of affiliates and their employers – as it is part of the public network after the 2008 Constitution.

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The three deceased were members of a WhatsApp group created last year by 17 patients at IESS Hospital Teodoro Maldonado Carbo, in Guayaquil, who required these medicines as oral chemotherapy prescribed by breast and lung cancer specialists …

To proceed with the delivery of the drug, the process includes the analysis of the molecule by a commission led by the MSP in which its effectiveness is studied, as reported by the authorities. Then the governing body of public health gives way to the acquisition.

Some obtained precautionary measures after initiating lawsuits in the courts, but even then the delivery is not immediate. Jorge, 72, who was diagnosed with lung cancer in January 2015, waited 85 days since the IESS learned of the court ruling to have afatinib on Monday of this week.
Delays in delivery

The same Monica, 56, who received 93 days of the injunction. “My doctor had permission so I had to schedule with another,” he says.

The delay depends on the terms of the resolution. In both, the referral to an external provider is determined until the Teodoro Maldonado hospital makes the purchase. But the transfer did not materialize.

Carolina, 32, knows that a public purchase process takes months and she asked the judge to determine the transfer to a specific provider in which she is covered by private insurance coverage. Thus, he was only one month without regorafenib, which costs $ 7,800 for the 84 pills: “The resolution does not guarantee anything. After the IESS did not want to pay the external provider because the referral was missing. I know that this pill will not cure me, but for someone with cancer every day counts. ”

In his case the tumor, which weighed 4 pounds after the removal, was detected in the liver in November 2014. It is a cancer considered rare (fibrolamenar hepatocarcinoma) because it does not present symptoms and occurs in children and young people with no history of hepatitis or cirrhosis: “I did not even have high tumor markers. I went to the doctor when I felt a lump under my right rib. ” Since then he has had smaller tumors.

The drug, he says, has allowed him to continue working ten hours a day, climb the Chimborazo last August without a quarter lung and with half a liver after four surgeries, survive with quality, he says.

It is a new dawn that Jorge and Monica have also shown with afatinib whose box with 28 tablets is worth $ 3,108. Both have bought it. “My father-in-law retired with 57 years of contributions had never used the IESS”, tells Lorena about Jorge, who resumed his activities in the field.

In responses sent to this Journal, the MSP includes the drug afatinib and others among the options as treatment in lung cancer. But it is not available in the public network for timely access.

Other affiliated and retired patients grouped in the Esperanza y Vida Foundation have required fulvestrant injection, subcutaneous trastuzumab, as indicated. A more than those who have heart disease, who request brilinta. This newspaper requested an interview with the MSP and the IESS on the subject of cancer and access to medicines, but there was no response at the close of this edition.
Claims for medicines

The Minister of Health, Verónica Espinosa, described as worrying the use of lawsuits to access medicines not available in public coverage in a forum, in October, in Quito: “Health can not be guaranteed by decree or by judicial order or sentence , health needs resources, funding sources and citizen participation, a prioritization, needs limits, and that is what we are invited to discuss, “he said according to the MSP website.

Julian Molina, specialist in treatment of lung cancer at the Mayo Clinic in the US, says there is a gap on where science is going in the treatment of this type of cancer compared to what is done in Ecuador. “When diagnosed in the US First a DNA (genetic) study is done to see if there is a mutation in a gene for which there is treatment with a medicine. ”

In September (of 2016) they prescribed the pill.
It was the end of the year until they told me they could not buy it in the IESS. M
My mother died in May. ”
Xiomara, Daughter of the affected

Then, Molina adds, if the patient does not have that alteration, the option is immunotherapy that consists of treating the immune system to be able to recognize these tumor cells and attack them. “Chemotherapies are only for a small group of those patients who do not meet the requirements for immunotherapy,” he says.

“When you treat with immunotherapy, there are 20% or 25% of patients who have a very long benefit of five years or more,” he adds.

The specialist, who attended the International Oncology Congress of the Fight Against Cancer Society in Guayaquil this month, added that cancer should be given a chronic disease approach: “Keep the patient alive … These treatments come in almost all the types of cancer. Ecuador is not letting social security have these medicines accessible to patients. ”

Of the three deceased: Audrey, Walter and Andrea, the first two died days after they began taking the medication after a wait of months since they were prescribed. Andrea never had it. His daughter indicates that they did not tell him in the IESS the name, as if to buy it. Read Article