Clinical Therapeutics/Volume 36, Number 8, 2014 Access to Antihypertensive Agents in Brazil: Evaluation of the “Health Has No Price” Program Joa˜o Leopoldo Oliveira Araujo, PharmD; Mariana Donato Pereira, PharmD; Fernando de Sa´ Del Fiol, PhD; and Silvio Barberato-Filho, PhD Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Sao Paulo State, Brazil ABSTRACT Purpose: This article aims to evaluate access to antihypertensive agents during the first year of the “Health Has No Price” Program (Saúde Não Tem Preço [SNTP]) in Brazil. Methods: A longitudinal and observational study was performed based on the number of antihypertensive med- ications supplied in 55,000 private pharmacies distributed throughout the Brazilian territory during the period Feb- ruary 1, 2010, through January 31, 2012. The number of antihypertensive pills supplied in the first 12 months of the SNTP Program was compared with the number of pills supplied in the 12 months before its implementation. Findings: Six antihypertensive medicines showed an increase between 32% and 120% in the number of pills supplied in the first year of the program. In this same period, the growth of the Brazilian pharmaceutical market was  13%. Additionally, 11 medicines con- taining the same active ingredients as the antihyperten- sive agents in the SNTP Program, but at concentrations not available for free, were analyzed; it was found that none showed a change 48%, and 5 showed a red- uction in the number of pills supplied after the imple- mentation of the SNTP Program. The analysis of 7 fixed-dose combinations not available in the SNTP Program that were formulated with the same active ingredients showed a change below the annual percent- age growth of the Brazilian pharmaceutical market. Implications: The SNTP Program may have contri- buted to increased access to antihypertensive medicines in Brazil. (Clin Ther. 2014;36:1191–1195) & 2014 Elsevier HS Journals, Inc. All rights reserved. Key words: access to health services, antihyperten- sive agents, cardiovascular, health policy, health system. INTRODUCTION In Brazil, the public health system (Sistema Único de Saúde [SUS]), created in 1990, took over guaranteeing integral therapeutic assistance, including pharmaceut- ical assistance. Brazil is one of the few countries that maintains a policy of free access to essential medicines in a decentralized network of health units, with 440,000 basic health units (health centers) covering almost all of its 5565 municipalities. 1,2 According to data collected in the Pesquisa de Orçamentos Familiares (Household Budget Survey) from 2008 through 2009, whereas the poorest Brazil- ian families committed up to 12.0% of their per capita monthly income to the acquisition of medications, the richest families committed only 1.7% of their per capita monthly income to medications. 3 Although the percentage of the world population without access to essential medicines has decreased, it is estimated that 1.3 to 2.1 billion people do not have access to them, especially in poor and vulnerable populations. 4,5 Whether funded by patients, subsi- dized by governments or health systems, or even distributed free of charge, the cost of medicines has a decisive role in the financial sustainability of individ- uals and systems. The concept of economic accessi- bility assumes that the cost of medicine does not compromise an excessive proportion of the family income, forcing the user to forego other basic needs to purchase the necessary medicines. 6 Other barriers that make access more difficult are unavailability, trans- portation difficulties, and the level of information the users have about their health services. 7 With the aim of expanding access to medicines, in 2006, the Brazilian government began to subsidize part of the cost of the medicines used in hypertension treatment through a system of copayment of  90% of the value of the medicines purchased in private Accepted for publication June 2, 2014. http://dx.doi.org/10.1016/j.clinthera.2014.06.003 0149-2918/$- see front matter & 2014 Elsevier HS Journals, Inc. All rights reserved. August 2014 1191