Specialized Component of Pharmaceutical Care: the state organization and access to medicines.

This study aimed to characterize the organization of the Specialized Components of Pharmaceutical Care (Componente Especializado da Assistência Farmacêutica - CEAF) in Brazil and to categorize the different strategies as centralized or decentralized, pointing out the limits, challenges, and potentialities for access to medicines. A retrospective quantitative study of CEAF drug dispensing data in 2023 was carried out in the 26 Brazilian states and the Federal District, with a special focus on medicines recommended for the treatment of rheumatoid arthritis (RA). Data were obtained mainly from the High-Cost Procedure Authorization (Autorização de Procedimento de Alto Custo - APAC) system. A set of indicators has been developed. Data from 210,640 users, residents of 5,086 (91%) Brazilian municipalities were analyzed. Dispensation was carried out in 189 municipalities (3.4%). Approximately half of the users of RA medications in the CEAF are in the Southeast, followed by the South and the Northeast, according to the order of demographic density. The CEAF dispensing is essentially centralized, especially in the North and Northeast. The divergences and incompleteness of databases is a problem that needs to be resolved in order to enhance their use in guiding decision-making.