It was sanctioned by the government Law 14,307/22 with new rules for operators regarding coverage of oral cancer treatment.

Soon, health plan operators will have to adapt to changes in the coverage of procedures and events available to their beneficiaries.

According to the law, the supply of medicines for oral and home use approved by Anvisa (National Health Surveillance Agency), becomes mandatory within ten days of medical prescription.

Furthermore, Patients must also continue therapy at home covered by the operator, without the need for hospitalization to carry out the treatment.

An amendment to the law highlights that medicines and procedures not available to plans do not need to be included by the ANS in its List.

Currently, it is estimated that around 50 million Brazilians who use medical insurance in the country will be impacted by these planned changes.

But this implementation will not occur now, as the ANS (National Supplementary Health Agency) has a deadline of 120 days, which can be extended for another 60, to include the therapy in the List of Health Procedures and Events.

When this happens, We will bring more information about updates here on our blog. and how you can adapt your operator to the new rules proposed by ANS.

Read too: The importance of meeting the deadlines established by ANS.

Creation of a Commission was also established in the law

In addition to the new coverage rules, the law also promoted the establishment of the Commission for Updating the List of Procedures and Events in Supplementary Health to advise the ANS in decision-making.

Within the team there will be members from different groups, such as the Federal Council of Medicine (CFM), Brazilian Medical Association (AMB), health service providers, consumers and health professionals related to the procedures.

Together, this committee will analyze scientific evidence on the efficacy, accuracy, effectiveness, efficiency, usability and safety of the item under analysis, be it a medicine, product or procedure.

It’s time to pay extra attention to your healthcare provider’s costs

When this obligation comes into force, your health plan operator needs to be prepared, because it could generate significant additional costs among the planned and actual expenses.

The best way to control your operator's costs is by implementing an efficient medical audit solution.

Through this system that generates several benefits for the company, there is the authorization of procedures and OMPEs, with the purchasing automation with optimized prices and supplier analysis in search of the best cost-benefit ratio.

In addition, there is also a reduction in costs through medical monitoring of the patient and also provision of payment to service providers with greater agility and accuracy.

All of this is carried out automatically, integrated, completely digitally and provides operators with greater transparency in the transactions carried out.

Large operators already use the SAUDI System and their financial management has become more agile, simplified and assertive.

To learn more about this solution, contact contact a specialist from the SAUDI team and schedule an objective, no-obligation presentation!