Análise comparativa da disponibilidade de medicamentos psicotrópicos em listas de medicamentos essenciais.

Abstract

The National Medicines Policy (PNM) establishes as a fundamental guideline to guarantee access and rational use of medicines (URM), the creation of a list of essential medicines called the National List of Essential Medicines (RENAME). However, for the selection process to be cost effective and based on the best scientific evidence to meet the priority demands of the population, the World Health Organization (WHO) establishes a model list of essential medicines (EML) that must be adopted by member countries . To this end, this work aimed to identify and compare the psychotropic medications present in RENAME with EML, and verify similarities and differences between the lists. Methodologically, a documentary analysis was carried out, with an exploratory, descriptive and quantitative nature of the RENAME 2012 and 2022 editions, as well as EML 2013 and 2023. In this way, the medicines were counted, classified using the 2nd level of the Anatomical Classification system- Therapeutic-Chemical and Defined Daily Dose (ATC/DDD) and related according to the active ingredients. Thus, for each active ingredient, a critical assessment was carried out considering the Pharmaceutical Assistance (AF) financing component it belonged to and its presence in the EML (2013 and 2023 editions). The data obtained was subjected to analysis using Microsoft Excel (2016 version). The results demonstrated that in 10 years RENAME discreetly increased the list of psychotropic medications offered, in which in 2012, RENAME included 35 psychotropic drugs, which represented 8.47% of 413 drugs present in the edition. While, in 2022, RENAME expanded its list to 46 psychotropics, corresponding to 8.7% of the total of 529. Furthermore, a notable trend throughout the decade is the significant decrease of psychotropics in the N05 categories intended for antipsychotics, anxiolytics, sedatives and N06 referring to psychoanalytics, such as antidepressants. It is worth noting that the Specialized Component of Pharmaceutical Assistance (CEAF) was the biggest beneficiary, although primary care is responsible for meeting a greater demand for TMC. On the other hand, there are significant differences between WHO recommendations and RENAME's selection of psychotropic drugs. When comparing EML 2013 with RENAME 2012, it is noted that both have more antiepileptics and anxiolytics. However, the differences after 10 years are notable, since EML 2023 reduced the supply of antiepileptics (N03) to the detriment of the availability of anxiolytics (N05) and antidepressants (N06. Therefore, it is possible to state that there are standardized non-essential drugs in national financing list and this appears to be associated with a lack of alignment with the definition of essential medicines adopted by the WHO, as well as growing market pressure to incorporate health technologies. This study could contribute to assertive health decisions, since managers can have access to the comparison carried out and will be able to develop a

more effective selection of psychotropic drugs to guarantee the efficiency of PA. To date, this research is unprecedented and there are no precedents in the literature with the same objectives analyzed here.