Center for Research on Science, Technology and Society

Fernanda De Negri, Carlos Eduardo R. de Mello, Adriano Cabral Linhares Mourthe

1.   Introduction

The Brazilian government is responsible for a significant volume of pharmaceutical purchases, which also represent a substantial portion of the total public health expenditures in the country. According to Vieira (2018), expenditures of the Unified Health System (SUS) on medicines increased from R$14.3 billion in 2010 to just over R$18 billion in 2016. This increase contributed to the rise of medicine expenses' share in SUS from 11% to 16% during the analyzed period.

Unfortunately, despite its relevance, there is a lack of detailed studies analyzing the behavior of pharmaceutical purchases by the federal government. This text aims to fill this gap by presenting the evolution of medicine acquisitions by the federal government over the last 20 years and identifying relevant patterns and trends.

2.   Data and methodology

In this study, we investigated the pharmaceutical purchases made by the Brazilian federal government over the past 20 years using the ComprasNet Module of the Integrated System for General Services Administration (SIASG).

The SIASG is a government system designed to support the management of procurement processes, contracts, and general services. It is used by several public bodies and entities, including those responsible for medicine procurement. The ComprasNet is the module within SIASG responsible for centralizing information and facilitating government purchases, promoting greater efficiency, transparency, and control of public resources.

The federal government identifies products in this system using a specific catalog known as the "Material Catalog" - CATMAT. This catalog records the description and unique identification of all materials available for public purchases and organizes them based on a taxonomy of classes. Among these classes, class 6505 encompasses drugs and medicines and was utilized in this study to identify and analyze all pharmaceutical acquisitions made by the federal government from 2000 to 2021. It is worth mentioning that the SIASG also includes some transactions from states and municipalities, which have been excluded from the scope of this analysis.

Each record corresponds to a purchase and contains detailed information about the product description, its identifying code, price, quantity acquired, purchasing agency, supplier's name, as well as information about the procurement modality, date, justifications for exemption from bidding, disputes, and more. In total, there are 1,294,524 records and 27 attributes (variables) in this dataset.

All products acquired by the federal government and present in the SIASG database (including medicines) have a unique and mandatory identifier. In the case of drugs and medicines, each identifier corresponds to a specific medication, defined by its active ingredient, dosage, and form of presentation. Therefore, the same active ingredient can have multiple identifier codes if there are variations in dosage (e.g., 20mg/mL, 100mg/mL, etc.) and form of presentation (e.g., tablet, suspension solution, etc.).

An important limitation of the SIASG data is the lack of information about the therapeutic class of each medication. This information can be particularly useful for investigating competition and identifying potential substitutes in the market. As a solution, each of the medications present in the federal government's purchases was associated with a therapeutic class using a table available from the Brazilian Health Regulatory Agency (Anvisa) that lists registered medications in Brazil. Since Anvisa's classification is based on the medication's name (rather than a standardized code), the identification of the class was made based on this name, which sometimes resulted in imperfect associations due to errors or spelling differences, especially in the SIASG database. Nevertheless, a manual mapping effort was carried out for the most relevant medications in terms of expenditure volume to ensure significant coverage of the expenditures. This automated and manual association process allowed the identification of the therapeutic classes for approximately 90% of the total pharmaceutical purchases made by the federal government.

We adjusted monetary information, such as prices and purchase values, for inflation using the IPCA (Consumer Price Index) and brought them to constant values for 2022.

3.   Trends in medication acquisitions and their distribution

The first aspect to highlight in the analysis of pharmaceutical purchases by the Brazilian federal government is its significance in the Brazilian pharmaceutical market. According to the Executive Secretariat of the Chamber of Market Regulation of Medicines - SCMED (2020), the pharmaceutical sector's revenue in Brazil exceeded R$86 billion in 2019, with R$59 billion coming from chemically-synthesized drugs. During that year, the federal government was responsible for acquiring over R$14 billion worth of drugs and medicines, accounting for approximately 16% of the total sector revenue.

Despite the relatively stable number of distinct products purchased by the federal government over the last decade, around 40,000 to 50,000 items per year, there has been a significant growth in the value of federal medicine purchases since 2008. One plausible explanation for this increase is the centralization of drug procurement for Brazil's Unified Health System (SUS) at the federal level rather than the state and municipal levels. This strategic move has minimized the fragmentation of purchases and bolstered the government's bargaining power in negotiations. This development was a result of a decision by the federal public administration in the late 2000s and is particularly pronounced in the acquisition of complex and high-cost medications.

Another possible reason that has contributed, though to a lesser extent, to the expansion of the federal government's medication expenses is the phenomenon of judicialization. This occurs when citizens resort to legal action to gain access to medications not available or not provided free of charge by the SUS. Vieira (2020) demonstrates that expenses resulting from judicial decisions increased their share in federal medication expenditures from 4% to over 7% between 2012 and 2018. The “Farmácia Popular” program, created in 2004 aimed to distribute some essential medicines to the Brazilian population, has also contributed to the growth of these expenses (Vieira, 2018).

Figure 1. Quantity of items and value of medications acquired by the federal government between 2000 and 2021 (at 2022 prices)

Source: Integrated System for General Services Administration (SIASG). Compiled by the authors                     

Regardless of the weight of each of these or other potential factors, there is a significant upward trend in medication expenses by the federal government. As shown in Figure 1, these expenditures have surged from just over R$2 billion in the year 2000 to around R$18 billion in 2020 and further to R$25 billion in 2021.

The distribution of medication purchases by therapeutic class can help to understand the profile of medicines acquired by the federal government. This information is particularly valuable because the therapeutic class defines a relevant market for analysis.

The Brazilian Health Regulatory Agency (Anvisa) classifies registered medicines and pharmaceutical products into more than 600 therapeutic classes. During the period from 2000 to 2021, the federal government recorded acquisitions of medications in over 200 different classes, with the major ones, in terms of values, presented in Table 1.

Table 1. Total value of medications acquired by the federal government in the period 2000-2021, according to their main therapeutic classes (in million Brazilian Reais - at 2022 prices).

Source: Integrated System for General Services Administration (SIASG) and Anvisa. Compiled by the authors. Note: *Medications that were not identified with a therapeutic class by the authors and those classified by Anvisa as "other products not classified under a specific therapeutic class”

Vaccines constitute the federal government's main purchase item in the drugs and medicines category, with R$41 billion in acquisitions between 2000 and 2021, accounting for 18% of the total. Following vaccines, medications for cancer treatment (antineoplastic drugs) represent 7% of the total purchases, antivirals account for 6%, blood derivatives at 6%, antiretrovirals at 5%, and anti-inflammatory drugs at 5% are among the major groups of medications acquired by the federal government.

Each year, the 10 to 15 most frequent therapeutic classes of medications acquired by the federal government represent over 70% of the total value of these purchases, although the weight of each class has varied over time. For instance, between 2000 and 2005, the primary types of medications acquired by the federal government were antivirals and homeopathic medicines, which accounted for nearly half of the purchases during that period, followed by blood/plasma fractions and antiretrovirals. In the period from 2006 to 2010, antivirals and vaccines continued as the two main classes, but antineoplastic drugs and enzyme replacements, used for rare genetic diseases in which the patient does not produce sufficient amounts of a specific enzyme, gained participation. Immunomodulators, medications with the ability to regulate the immune system to strengthen the body's response against infections or cancer or to reduce the response when the system is deregulated or overactive, also emerged as a relevant class in federal purchases during this period.

Finally, in the period from 2015 to 2021, the participation of vaccines in federal purchases increased even more, mainly due to the acquisition of immunizers for the Covid-19 pandemic.

Figure 2. Percentage share in federal medication purchases of the most relevant therapeutic classes in the period 2000 to 2021, according to their participation in different sub-periods

Source: Integrated System for General Services Administration (SIASG) and Brazilian Health Regulatory Agency (Anvisa). Compiled by the authors. This graph shows the percentage share, in the presented sub-periods, of the most relevant therapeutic classes throughout the entire period from 2000 to 2021. Therefore, some relevant therapeutic classes in specific sub-periods may not appear in this graph

Just like they are concentrated in certain therapeutic classes, federal purchases are also concentrated in a relatively small number of medications. On average, the top 20 medications account for a significant portion of these purchases each year. In the early 2000s, they represented over 80% of the total drug and medication purchases. This percentage gradually decreased over the years, although in 2021, the top 20 drugs still accounted for 56% of the federal spending on medications (figure 3).

Despite this concentration of purchases each year, the ranking of the top 20 most purchased medications varies annually, although some substances consistently remain at the top of the list. Among the most purchased medications by the federal government is recombinant factor VIII, which is used in the treatment of blood clotting disorders, such as hemophilia A. Medications with the "abe" suffix, such as adalimumab, infliximab, and trastuzumab, are also significant in government purchases. They are monoclonal antibodies designed to target specific proteins or cells in the body and interfere with biological processes associated with various diseases, from rheumatoid arthritis to cancer. Other notable medications are those with the "vir" suffix, such as darunavir, sofosbuvir, and dolutegravir, which are antivirals used in the treatment of different infections.

Figure 3. Total value and percentage share of purchases for the top 20 medications acquired by the federal government each year: 2000 to 2021

Source: Integrated System for General Services Administration (SIASG). Compiled by the authors

4.   Final remarks

Public expenditures on medications are highly concentrated in a few items, which account for a significant portion of the total spending. Therefore, analyzing the evolution of these purchases is essential to support public strategies for improving the quality of these expenses and, why not, reducing the costs of the Unified Health System (SUS). Identifying the main items of expenditure can contribute to the development of strategies to reduce healthcare system costs.

5.   References

SCMED. 2020. “Anuário Estatístico do Mercado Farmacêutico”. Brasília, DF: Anvisa.

Vieira, Fabiola Sulpino. 2018. “Evolução do gasto com medicamentos do Sistema Único de Saúde no período de 2010 a 2016”. Texto para Discussão n. 2356. Brasilia: Ipea.

———. 2020. “Direito à Saúde no Brasil: seus contornos, judicialização e a necessidade da macrojustiça”. Texto para Discussão n. 2547. Brasilia: Ipea.

This work was funded by the Brazilian Ministry of Health (TED No. 06/2022)