title: [Costly drugs: analysis and proposals for the Mercosur countries].
abstract: OBJECTIVE
  Determine how the Mercosur countries access, regulate, and finance costly drugs and propose joint selection and financing strategies at the subregional level.
  
  
  METHODS
  Qualitative design, using content analyses of primary and secondary sources, document reviews, interviews, focus groups, and case studies. The variables selected included: selection criteria, access, financing, and regulations in the various countries. Costly drugs were divided into those that do not alter the natural course of the disease and those with demonstrated efficacy, using the defined daily dose to compare the costs of classical treatments and those involving costly drugs.
  
  
  RESULTS
  The Mercosur countries generally lack formal strategies for dealing with the demand for costly drugs, and governments and insurers wind up financing them by court order. The case studies show that there are costly drugs whose efficacy has not been established but that nonetheless generate demand. The fragmentation of procurement, international commitments with regard to intellectual property, and low negotiating power exponentially increase the price of costly drugs, putting health system finances in jeopardy.
  
  
  CONCLUSIONS
  Costly drugs must be regulated and rationally selected so that only those that substantively benefit people are accepted. To finance the drugs so selected, common country strategies are needed that include such options as flexible in trade agreements, the creation of national resource funds, or joint procurement by countries to enhance their negotiating power.
authors.affiliation: Dirección Nacional de Relaciones Internacionales, Ministerio de Salud, Argentina.
authors.forename: Gustavo H
authors.initials: GH
authors.lastname: Marín
authors.forename: María Andrea
authors.initials: MA
authors.lastname: Polach
mesh_terms: D000465:Algorithms; D001118:Argentina; D001938:Brazil; D003132:Commerce / Q000191:economics / Q000331:legislation & jurisprudence; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000191:economics; D016527:Drug Costs / Q000331:legislation & jurisprudence; D005381:Financing, Organized; D014943:Global Health / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics; D006301:Health Services Needs and Demand; D007390:International Agencies / Q000191:economics / Q000458:organization & administration*; D007391:International Cooperation / Q000331:legislation & jurisprudence; D010239:Paraguay; D004364:Pharmaceutical Preparations / Q000191:economics* / Q000600:supply & distribution; D011203:Poverty; D035703:Therapies, Investigational / Q000191:economics; D014583:Uruguay
chemical_list: D004364:Pharmaceutical Preparations