ARS will include new medications due to TSA failure; they must include surgeries, antiretrovirals in basic plan

Santo Domingo, R.D. – In a ruling that prioritizes the health protection of citizens, the Superior Administrative Court (TSA) rejected the provisional suspension request from the Association of Medical Equalization and Health Risk Administrators (ADIMARS) against Resolution 624-02 of the National Council of Social Security (CNSS) which establishes the model of Per Capita Differentiated. The TSA considered that ADIMARS’ request intended to revoke a measure whose interruption would put at risk the access to health services for millions of Dominicans, violating the principles of the Social Security System. The precautionary measure of the guild representing ARS Futuro, ARS GMA, ARS Meta Salud, ARS YUNEN, ARS Renacer, ARS CMD, among others, sought to prevent the full and complete fulfillment of the regulations that provide for the implementation of a Differentiated Per Capita by age and sex for the redistribution of resources of the Family Health Insurance in the Contributory Regime. Furthermore, CNSS Resolution 624-02 includes coverage for more than 40 new medications in the Basic Health Plan (PBS) Catalog, antiretrovirals for HIV and Hepatitis, treatments for tuberculosis, breast reduction surgeries, among other procedures needed by the population. Faced with this situation, the contentious body denied ADIMARS’ precautionary request, insisting that private interest cannot prevail over the protection of the general interest.

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The Association of Medical Equalization and Health Risk Administrators (Adimars) has based its opposition to the Differentiated Per Capita on the alleged bankruptcy of the ARS belonging to the union. However, this resource redistribution scheme seeks to maintain the balance and sustainability of the system by ensuring timely care and health benefits for affiliates. During the process, the Superintendency of Health and Labor Risks (SISALRIL), the Health Risk Administrator of the Dominican Medical College (ARS CMD), the Dominican Association of Health Risk Administrators (Adars), among others, intervened.