On June 6th, 2015, Law No. 20,850, which
creates the Financial Protection System for Diagnostics and
Treatment of High Costs, and pays posthumous tribute to
Luis Ricarte Soto Gallegos, has been published.
This law creates a financial protection system for diagnostics and
high cost treatments which will be defined by the Ministry of
Health by means of a Supreme Decree.
High cost treatment is defined as a treatment
which includes pharmaceutical products, foods or medical devices
related to diseases and health conditions and to the assistance
necessary for confirming its diagnostic and follow up; which due to
the high costs involved, hinders the access to diagnosis and
treatment, or catastrophically impacts the economy of the
beneficiary. The aforementioned includes oncological, immunological
and rare diseases.
All the beneficiaries of the health insurance
systems of Chile can have access to this protection, including both
the public and private systems, except for treatments covered by
the labor accidents and professional diseases law, the mandatory
insurance law for personal accidents caused by motorized vehicles
and by the Agreement of Health Insurance through the Additional
Coverage for Catastrophic Diseases (CAEC). In this last case, the
beneficiaries should first use the CAEC coverage and if the
treatment is not covered, they can access to the protection of this
law.
On the other hand, the law includes provisions which modify the
Sanitary Code, such as article 100 of said code in
connection to the regulation of incentives executed with
promotional ends (now limited only to those who
participate in the sale of pharmaceutical products), creates a new
Title V for Clinical Trials for Pharmaceutical Products and
Medical Devices and a new Title VI regarding
Responsibility for Defective Sanitary
Products.
According to the first transitory article, the provisions of the
law will be effective once the supreme decree which states
the High Costs Diagnostics and Treatments (Article 5) is
in force. Nonetheless, such supreme decree will not be issued until
the publication of: (i) the regulations which establish the
national threshold of annual cost to determine if a diagnosis or
treatment is of high cost (Article 6); and (ii) the regulations
which state the conditions under which the providers shall inform
beneficiaries of their right to access the financial protection
comprehended in the system (Article 13). Such regulations shall be
issued within 90 days as of the publication of the law, namely,
before September 6th, 2015.
Originally published in June 2015
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.