ADSE implements prior authorization for oncology treatments

Starting October 1, ADSE beneficiaries undergoing oncological treatment will face new rules requiring prior authorization for the reimbursement of medications and therapies in private hospitals. This change affects 398 listed medications, including high-cost biological therapies.

The new regulations coincide with a reduction in the amounts paid by ADSE to private providers. According to the Associação 30 de Julho, several surgical procedures will also see significant price reductions, with nine interventions—including prostatectomies and radical hysterectomies—facing cuts exceeding 1,800 euros. The association expressed concern regarding the lack of prior communication and the potential impact on patient access to care.

In response, ADSE stated that the updates to the medication tables aim to align with market prices rather than serve as a cost-saving measure. The institute clarified that oncology treatments remain 100% financed by ADSE, meaning there should be no direct cost impact on users. ADSE noted that price decreases reflect lower costs paid by private hospitals to pharmaceutical companies and reported no formal complaints or suspensions of agreements from private providers. The healthcare group CUF indicated it does not foresee any disruption to its services.