title: Exceptional circumstance drug dispensing: history and expenditures of the Brazilian Ministry of Health.
abstract: OBJECTIVE
  To describe the technical aspects of the Exceptional Circumstance Drug Dispensing Program of the Brazilian Ministry of Health, especially with respect to the cost of dispensed medication.
  
  
  METHODS
  Technical information was obtained from the ordinances that regulate the Program. Expenditure from 2000 to 2007 was obtained from the Sistema Único de Saúde's (Unified Healthcare System) Outpatient Information System. All drugs dispensed between 1993 and 2009 and the amount and cost of each procedure were evaluated, based on information from the high-complexity procedure authorization of each of the country's states.
  
  
  RESULTS
  The Program changed with the increase in the number of pharmacological agents and presentations distributed by, and the number of diseases contemplated in the program. In 1993, the program distributed 15 pharmacological agents in 31 distinct presentations. This number increased to 109 agents in 243 presentations in 2009. Total Ministry of Health expenditure with medications was R$1,410,181,600.74 in 2007, almost twice the amount spent in 2000, R$684,975,404.43. Diseases whose expenditure increased in the period included chronic renal insufficiency, transplantation, and hepatitis C.
  
  
  CONCLUSIONS
  The Exceptional Circumstance Drug Dispensing Program is in constant transformation, aimed at building instruments and strategies that can ensure and expand access to medication among the population. Alternatives should be sought to decrease the financial impact of the Program to a level that does not impact other sectors of the health care system, given the high cost associated with novel interventions.
authors.affiliation: Centro Paulista de Economia da Saúde, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Claudia Mezleveckas
authors.initials: CM
authors.lastname: Carias
authors.forename: Fabíola Sulpino
authors.initials: FS
authors.lastname: Vieira
authors.forename: Carlos V
authors.initials: CV
authors.lastname: Giordano
authors.forename: Paola
authors.initials: P
authors.lastname: Zucchi
mesh_terms: D001938:Brazil; D016527:Drug Costs; D035082:Federal Government; D005102:Health Expenditures; D006291:Health Policy / Q000191:economics; D006297:Health Services Accessibility; D006526:Hepatitis C / Q000191:economics; D006801:Humans; D007880:Legislation, Drug; D009313:National Health Programs / Q000191:economics*; D004364:Pharmaceutical Preparations / Q000191:economics* / Q000600:supply & distribution; D010593:Pharmaceutical Services / Q000191:economics*; D051436:Renal Insufficiency, Chronic / Q000191:economics; D014180:Transplantation / Q000191:economics
chemical_list: D004364:Pharmaceutical Preparations