In a recent decision, the Superior Court of Justice understood that health plans are not obliged to provide a certain cannabidiol-based medication for home use, as it is a medication that is not listed by the ANS (National Health Agency).
The controversy concerns a request made for the supply of prescribed medication for the treatment of a beneficiary diagnosed with autism spectrum disorder.
In its reasoning, the STJ reinforces the understanding that Law No. 9,656/1998 only obliges health plans to provide the medications listed in the ANS list, so that other procedures and medications that are not included in the law, in the contract or in a regulatory standard, are not subject to coverage provided by the plan operator, even if the requirements of §13 of art. 10 of the aforementioned law are met.
This decision took into account the existence of precedents from the same court regarding the coverage of cannabidiol-based medicine, having, however, examined the issue from the point of view of the administration of the medicine at home, that is, outside the health unit environment and without the intervention of a health professional.
The decision highlighted, however, that coverage of the medication by the plan will be mandatory if it is administered in a healthcare unit, or if its administration requires the intervention of a healthcare professional.
Therefore, until such medications become part of the ANS list, plans will not be required to provide them to beneficiaries.
