A abusividade das negativas dos planos de saúde para o fornecimento de medicamentos de alto custo

Abstract

The right to health is directly linked to the right to life and human dignity, as regulated by constitutional fundamental principles. In this context, health insurance providers often deny pharmacological treatments to their beneficiaries due to the high cost of medications, arguing exclusion from the list of minimum procedures, among other reasons. From a legal perspective, courts have consistently regarded such practices as abusive towards the rights of patients/beneficiaries, overturning the arbitrariness of health insurers and interpreting the law and contracts more favorably towards health and the insured's relationship with the provider. This article aims to substantiate the excessive practice that limits the rights of beneficiaries to access necessary medication for their therapies. It employs the qualitative method, conducting bibliographic research with the study of articles, books, case law, and laws to understand the phenomenon of denials based on explanations and reasons provided by health plans. The study concludes that beneficiaries of health insurance have broad access to pharmacological treatments that are often denied. Therefore, it is possible to declare the abusive practice of health plans in denying broad access to health and the guarantee of life for their beneficiaries.