Diabetes and Access in Argentina

Yes, there is a Law named “National Diabetes Law” this is how it works. 

What is this law about?

The first legislative precedent on diabetes – at a national level – dates back to 1989, and Argentina is a pioneer in protecting the rights of people with diabetes in Latin America.

However, the spirit of the Law 23.753 to protect the rights of people with diabetes, providing coverage for medicines and supplies  for glycemic control, began to be cut short from its regulation by determining specific mechanisms of action.

This law used to establish 100% coverage for insulin and medications, and a gradual increase in the coverage of supplies such as test strips to reach 70% after a few years (in the case of needles and lancets the “discount” that was obtained for out of the pocket costs was minimal). With the new law in 2014 a greater coverage was established, but in the “not covered” cases (for example, Type 2 diabetes with oral treatment and only 50 test strips a year), that 70% ongoing discount that used to exist was lost and 100% is paid when the requirements for supplies (or more modern drugs) exceed the amounts established by the standard.

Modifications to the law

Among the many modifications suffered by the law observed at a distance by other countries and with sad eyes (but with happy hearts for our peers in Argentina) that the Ministry of Health of the Nation “will guarantee the production, allocation, and distribution of medicines and test items for self-management to all patients with diabetes, in order to ensure adequate therapy according to the scientific, technological and pharmacological knowledge approved, as well as its evolutionary control”, quoted textually.

In our countries, unlike let’s say the United Kingdom, the medicine stock and supplies for diabetes management is scarce. For example, in Mexico the health system is exclusively responsible for providing some types of insulin but not syringes or self-monitoring tools, thus providing incomplete treatment that undoubtedly results in an exorbitant cost for the patient and therefore the possibility of developing complications drastically increases.

In Argentina, the law contains an article that specifically talks about providing supplies and medicines and how this law should be reviewed every two years to include devices and advances (technology and medicines) in the coverage. Not only that, everything that a patient requires for their “self-management” must be covered 100%.  For this to be a reality, a medical prescription is needed, meaning the doctor will indicate the treatment in a prescription and of course the life condition must be confirmed on day 1. So, the doctor will verify that you live with diabetes.

About the law and its characteristics

Law: ley-26-914

Regulation: resolucion-no-11562014

The law establishes that the types and quantities of medicines and supplies covered must be updated every two years in order to take into account new medical and technological developments. This was not done in 2016 and the update that was made in November 2018 was incomplete because nothing mentions the monitoring technologies (either continuous or flash) or more modern drugs with proven efficacy for Type 2 treatment.

Test strips: Patients with an intensified treatment (basal and bolus insulin) will receive 1500 test strips per year, but patients with frequent risk of hypoglycemia, pregnant or in preconception care will be able to receive up to 1800 test strips per year).

About insulins: The provision of insulin is subject to the same requirements as the rest of supplies in Argentina: a medical prescription must be provided indicating the need for it and the units that each patient must take daily. Once this procedure is completed, the supply will be guaranteed by Law.

As in other countries, unfortunately not everyone has access to “new” insulins and in some regions of the country or low income areas, treatment with old insulins such as NPH is still prescribed.

The other side of the story

Although the law is fulfilled, it is a fact that this happens mainly in the case of patients with available resources and with inclusion in the social and labor system. In the most humble neighborhoods, where many people do not work, even today it can lead to cases of serious complications and even amputations in teenagers.

The so-called Diabetes Law is a national law of public order enforceable throughout the country, but … because Argentina is a federal country, in some jurisdictions the argument is that the province has not adhered to the law in order to play dumb in terms of their level of compliance. On the other hand there is a lack of information and empowerment for patients and they do not have the means to invoke their rights (the services of a lawyer are inconceivable for many).

These people have to go to hospitals to request strips and insulin, and although the State has to guarantee their supply, this does not always happen in real life, especially for the less fortunate as indicated above.

Immigration and access to treatment

In Lucy’s words: “As an immigrant, and before I could get integrated into the country’s system, I have experienced the lack of test strips and insulin.”

The Argentinian health system comprises three sectors: the public system, which is financed with public funds and depends on the provincial or municipal governments (hospitals and public health centers); the social security sector, which is financed by the contributions made by the active workers of the country and their employers (social and mutual services); and the private system (prepaid).

Conclusion: The Law exists, but it does not guarantee that all people with diabetes are covered and those who will be covered are those who are affiliated to Social, Prepaid or Mutual services.

The requirements

Even so, each healthcare provider in the different sectors has its additional requirements to provide people with diabetes with the supplies they need. “In the case of my mutual society” (OSPECON), clarifies Lucy, “a certificate of diabetes must be filled out every 6 months. This includes the need for ophthalmological, cardiac, ECG, and blood tests every 6 months, which are partially covered by the Mutual Society, but you have to pay the co-insurance out of pocket. As well as medical visits. So, we continue to spend an enormous amount of money on simply keeping ourselves alive, despite the Law.”

The “internal” requirements vary widely among different providers. On the one hand, it is logical that they provide coverage only to patients who effectively comply with their part of the treatment (regardless of the results that depend more on the diabetes education that they get and that the system does not necessarily offer), but the continuity or the formalities to guarantee it should be simpler and not so difficult in terms of time. “In my particular case”, adds Ana, “the only thing that they require me to do is to submit a new order with the list of medications, supplies and quantities, signed by my endocrinologist (the one in the system, not the one that really takes care of my treatment … that’s another story) once a year, because it is a centralized and digitized system, my clinical history can be accessed to verify data in a relatively simple way.”

It is noteworthy that the time taken to carry out these tasks in many cases deprives the person with diabetes from the normal activities of their daily lives. They have to submit prescriptions of what they need per month. In a few cases people can do it every three months or they have other arrangements, but it is not a regular thing.

And the conclusion

Health is one of the most violated rights in all our countries. While there are examples of successful work in Latin America such as Chile and Argentina, in many other regions there is still much to be done. Knowing about the situation and the laws of our neighboring countries can give us the tools to unite voices and the drive to work on demanding what we need in order to stay alive. What are you willing to do to make this a reality?

References

Argentine legislation can be checked at infoleg.gob.ar