Changes in the Mexican Healthcare System: Striving to Increase Public Access for High-Cost Drugs

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Mexican healthcare system

In this article we explore the ongoing changes and implications for manufacturers interested in gaining and keeping access in the public setting in Mexico.

The public healthcare system in Mexico consists of two main branches operating in parallel: the social security institutions providing employment-based insurance and the Institute of Health for Welfare (INSABI, formerly Seguro Popular) providing services for the uninsured. Historically, there have been significant healthcare disparities between these two organizations, prompting the current government to plan a series of reforms to standardize healthcare access across public institutions.

As part of these efforts, the government plans to introduce a new national formulary, increase the budget of the new Health Fund for INSABI, centralize drug purchases through the Secretariat of Finance and Public Credit (Hacienda), and eliminate out-of-pocket costs. Unfortunately, the COVID-19 pandemic has delayed actions to implement these reforms and stressed the healthcare budget, resulting in significant uncertainty.

Public hospitals incorporate new national formulary

Public hospitals started to incorporate the new national formulary (Compendio Nacional de Insumos para la Salud) in December 2020. It was designed to completely replace the previous national formulary (Cuadro Básico y Catálogo de Medicamentos) and the formularies of all social security institutions. Moving forward, decision-making for funding is going to be centralized, and cost-effectiveness and budget impact are expected to become more important to achieve funding.

In principle, this new formulary provides uninsured patients with improved access to high-cost drugs, as the majority of drugs already covered by social security institutions are included. However, experts point out that the budget necessary to make these treatments available for all is lacking. The COVID-19 crisis has significantly affected funding pathways and drug purchasing for the past 18 months.

  • Unanticipated costs of COVID-19 patients and vaccines
    Part of the budget of the new Health Fund for INSABI has covered unanticipated costs of COVID-19 patients and vaccines. This fund was intended to substitute the former Catastrophic Health Expenditure Fund under Seguro Popular for tertiary care, but now there are doubts as to whether the budget will be sufficient to cover treatment for other disease areas. Currently there are national drug shortages for the treatment of cancer, diabetes, HIV, and other severe diseases affecting Mexicans.
  • Slower procurement
    In addition to budget constraints, the centralization of drug purchasing through Hacienda has slowed down procurement without securing enough stock for hospitals. The government has recently engaged the United Nations Office for Project Services (UNOPS) to procure drugs through international tenders. Nevertheless, shortages are likely to continue for some time.
  • Patients still paying for medications
    Lastly, while INSABI had planned to eliminate out-of-pocket costs, patients are still paying for their medications in many hospitals despite affordability limitations aggravated by the pandemic.

Landscape for public healthcare in Mexico is challenging despite ongoing reforms

It is highly important for manufacturers to monitor the situation and put mitigation strategies in place to keep or gain access to high-cost drugs in the public setting. Raising awareness of the implications of missed treatments and engaging payers so budgets are prioritized to fund high-cost drugs is key to success.

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