Dominican Republic Reviews New High-Cost Medication Fund

High-cost medication fund

The National Social Security Council (CNSS) is reviewing a proposal from the Superintendency of Health and Labor Risks (SISALRIL) to establish a High-Cost Medication Fund, a mechanism designed to strengthen access to expensive treatments within the Dominican Republic’s Family Health Insurance system.

The proposed fund, known as FOMAC, would operate as a specialized, capitalizable account within the Family Health Insurance system and would be subject to oversight. Its financing model would rely in part on joint purchasing and economies of scale, with the goal of improving the availability and management of high-cost medicines for people covered by the Dominican Social Security System.

The proposal was discussed during a working meeting attended by senior officials from the health and social security sectors, including Public Health Vice Minister José Antonio Matos, Labor Vice Minister for Social Security Ramón Efrén Cuello, CNSS General Manager Aura Celeste Fernández Rodríguez and CNSS Deputy General Manager Anneline Escoto.

Fund Would Target High-Cost Treatments

According to Fernández Rodríguez, the proposal initially calls for the evaluation of 13 medicines intended to treat diseases with a significant economic impact on patients and the health system. The conditions identified include several types of adult and pediatric cancer, rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis and spinal muscular atrophy.

The proposed structure is intended to improve the way these treatments are financed and purchased, while making access more timely for beneficiaries who depend on costly therapies. Joint procurement could allow the system to negotiate purchases at greater scale rather than handling medicines through more fragmented purchasing mechanisms.

The initiative is being evaluated within the broader framework of the Dominican Social Security System, which provides health insurance coverage through the Family Health Insurance program. SISALRIL is the regulatory institution responsible for supervising health and occupational risk insurance within that system.

Proposal Follows CNSS Resolution

The FOMAC proposal follows CNSS Resolution 624-02, which instructed SISALRIL to design and submit a plan for the creation of a high-cost medication fund within three months. The resolution also required the proposal to include an initial cost assessment based on medicines prioritized by the Ministry of Public Health, as well as the mechanisms needed for the fund to operate.

The CNSS has previously used joint purchasing mechanisms as part of efforts to manage the cost and availability of medicines. Its Resolution 624-02 on priority public health medication funds also established a separate mechanism for purchasing medicines for tuberculosis, HIV and hepatitis B.

The broader policy challenge is to maintain access to treatments whose prices can place significant financial pressure on patients and the health system. A dedicated financing mechanism could allow authorities to plan purchases according to expected demand while using centralized procurement to improve the use of available resources.

CNSS Has Not Yet Approved The FOMAC

The proposed fund remains under evaluation by the CNSS. The working meeting brought together SISALRIL Superintendent Miguel Ceara Hatton, Social Security Treasurer Henry Sadhalá and Carlos Sánchez, director of the Ministry of Public Health’s Directorate of Access to High-Cost Medicines (DAMAC), along with technical teams from the participating institutions.

No final approval of the proposed FOMAC was announced in the information provided. The CNSS will continue assessing the structure, cost and operating mechanisms before determining how the fund could be implemented within the Family Health Insurance system.

If approved, the mechanism would become another component of the Dominican Republic’s efforts to improve financial protection and access to specialized treatments for people enrolled in the national social security system, particularly those requiring therapies with substantially higher costs than standard medical care.