[Complex clinical scenarios and treatment plans: current limitations, regional disparities in access, and reform proposals].

Cardio-kidney-metabolic syndrome and heart failure remain complex clinical conditions with significant healthcare implications. While therapeutic plans were intended to ensure appropriate prescribing, they often represent bureaucratic barriers. Facilitating or removing such plans could enhance treatment timeliness, therapeutic continuity, and equitable access. This work also includes other widely used cardiovascular drugs such as direct oral anticoagulants, which remain under therapeutic plan requirements despite robust clinical experience and safety data. In light of the recent AIFA resolution of July 4, 2025, abolishing the therapeutic plan for sodium-glucose cotransporter 2 inhibitors, this paper considers such a decision as a major normative and operational breakthrough. The removal of this prescribing barrier reflects both the safety and manageability of these drugs and represents a potential model for broader regulatory simplifications. It is therefore believed that overcoming the prescribing barriers imposed by therapeutic plans is not only a clinical necessity but also an organizational and ethical imperative, in order to avoid delaying or limiting access to care.