The PAMI announced in the last hours of Wednesday that
the benefit agreement that is in force until March 31 with the laboratories and pharmacies was
extended for eight months
. It was through a brief communication, signed by the five pharmaceutical chambers, which sought to reassure retirees who were risking cuts in medication coverage. However, although it was circulated that the agreement did not have many changes other than a price update,
Clarín
was able to confirm two important modifications, which appear suggested in a text crossed by euphemisms.
The signing of this agreement generated
tensions and fears
. Especially in the 5 million members - the majority, older adults - given the chance that the basket of remedies covered would be reduced to 100% and 80%.
Today the PAMI vademecum - that is, the list of medicines - includes
167 molecules
(also called "active ingredients"), each represented by several brands, which increases the coverage figure of the National Institute of Social Services for Retirees and Pensioners (INSSJP) to about 3,000 presentations of remedies.
It is worth remembering that each retiree has access to
six free medications per month
; The rest of the remedies he consumes will have coverage of up to 80%. In turn, retirees who cannot afford these co-payments can access the so-called “exception procedure”, which allows them to increase the 100% benefit to more medications.
Although the coverage of free remedies is maintained, it was not left intact. Photo: The Andes
From what has been said so far, the new agreement included
two changes
.
The first will be launched right now, in April, and involves a cut in the number of free medications per month and per person, which instead of six
will become five
, PAMI sources confirmed.
They hid behind the certainty that many
“abuse” the system
; affiliates who supposedly acquire free remedies and then
give them to family members
. As explained by the social work, any retiree who requires more than five free medications must request the
exception route
.
The second change is actually
a possibility
, but what is new is that the agreement signed this week left the door open for it to come to fruition. And it is a cut in the list of the 167 medications that PAMI delivers 100%, as Clarín had already anticipated.
According to two sources in the sector, the reduction possibly includes around
30 active ingredients
, which the member will be able to continue acquiring, but with co-payments. If it comes to fruition, they will almost certainly be medications considered “non-essential,” such as various over-the-counter medications (from pain relievers to vitamins, for example).
It is true that a good part of the new agreement provides continuity to the benefits in force until now, but why didn't PAMI officially report any of this?
There is a possibility that the PAMI list of free medicines will be reduced.
Even, as will be seen, understanding these developments is not even easy. It requires a forced reading between the lines and playing the game of differences.
Changes to PAMI drug coverage
PAMI did not issue any official communication about the agreement with the laboratories nor did it disclose any cuts. However, from the communication area of social work they transmitted two messages.
The first was a simple communication (a WhatsApp message) in which they expressed that they dedicate “significant efforts to
ensure that each member receives the necessary benefits
, considering the current situation in the country,” and they confirm that “the total coverage of all treatments chronic and special conditions that require continued care, such as those related to oncology, diabetes, HIV, hemophilia, cystic fibrosis, hepatitis, among others.”
They also assured that they will maintain “
discounts on medicines
, reaching up to 80% in the PAMI sales price, as well as the exception route and social subsidy” and that, following the WHO guidelines, they reviewed the “pharmacological criteria to establish maximum therapeutic doses in medical prescriptions, thus reducing the risk of adverse effects.”
The second message was actually a pdf with an official communication that is not their own but from the pharmacy chambers: the Argentine Pharmaceutical Confederation (COFA), the Pharmaceutical Federation (FEFARA), the Argentine Federation of Pharmacy Chambers (FACAF), the Association of Mutual and Union Pharmacies of the Argentine Republic (AFMSRA) and the Farmasur Mutual Association (FMS).
What does that text say?
Medications through PAMI and a message between the lines
To know that the medications covered at 100% will go from six to five, you have to be suspicious of what
is not understood
. In this case, from the cryptic meaning of the following paragraph, reflected in the statement from the pharmaceutical chambers and transmitted by PAMI:
"On the other hand, PAMI proposed a policy of monitoring benefits and controlling consumption, based on health parameters, with the aim that its members' access to their medications is not affected."
What is a "policy for monitoring benefits and controlling consumption"? When asked, the clarification came, from which it appears that it is an immense euphemism to allude to the fact that there will be
a reduction from six to five medications
per month, in order to "control consumption."
It seems a somewhat absurd expression in terms of institutional communication, as if the population could not tolerate a cut of this magnitude (one more in the sea of daily disappointments). This is without counting the right of
PAMI
members to know this information.
Not far behind is the paragraph that supposedly “reports” a potential future cut in the number of molecules covered at 100%, text that is not only not clear but also appears in the version of the statement circulated by the pharmacy chambers themselves, but not in the version of that same statement that PAMI transmitted.
What does that paragraph say that PAMI "lost" along the way?
"In this framework, the creation of a new plan is contemplated, called Eventual Coverage, in which molecules that are not covered in the rest of the plans will be included, respecting the public price, with coverage of 40% and a linear bonus of pharmacies 10%. This new Plan will be implemented gradually, with the vademecum that will make it up still pending construction
.
As confirmed by the sources consulted, this new “plan” could have those remedies that are removed from the vademecum of medications that today have 100% coverage.
Oddities of institutional communication in times of crisis.
P.S.