Lawyer for high-cost medication · SPD Advocacia
High-cost medicine denied by the SUS: lawyer to file in the courts
Did the State, the city or the high-cost pharmacy deny the medicine your doctor prescribed? We serve patients and families in Anápolis, Goiânia and all of Goiás, also online. Tell us about your case in a few minutes and receive the analysis on WhatsApp.
Straight answer
Is the SUS required to provide high-cost medicine?
In many cases, yes. If the medicine is on the SUS lists and was not delivered, the State or the municipality can be required to provide it. If the medicine is registered with Anvisa but has not yet been incorporated into the SUS, the courts can also order it to be provided, as long as the patient proves the requirements set by the Federal Supreme Court, such as a well-founded medical report, the lack of a substitute in the SUS and the inability to pay. When waiting is risky, the request can be made with an injunction.
Which medicines
Medicines most often taken to court in Goiás
These are some of the medicines most often requested in court against the government in Goiás. The firm also reviews any other medicine registered with Anvisa.
Rituximab, abiraterone, pembrolizumab, nivolumab, ribociclib, abemaciclib, palbociclib, enzalutamide, pazopanib, sorafenib, sunitinib and bevacizumab.
Somatropin (growth hormone), semaglutide, liraglutide and insulin glargine.
Cannabidiol for epilepsy, autism and chronic pain, and drugs such as aripiprazole.
Omalizumab, ocrelizumab, ustekinumab, mycophenolate, nintedanib, ruxolitinib and human immunoglobulin.
What the courts require
When the SUS can be required to provide the medicine
If the medication is already on the SUS lists and was not delivered, the path is usually simpler: the judge indicates which public body must supply it. If the drug is registered with Anvisa but has not been incorporated into the SUS, the Federal Supreme Court set requirements that must all be proven at the same time:
The medication was requested from SUS and denied, or the request went unanswered.
There is no other medicine on the SUS lists that can be used instead.
Good-quality scientific studies show that the medicine works and is safe.
A well-grounded medical report explaining why the medicine is essential and which treatments have already been tried.
Conitec did not review the drug, took too long, or refused it without proper grounds.
The patient cannot pay for the treatment without compromising their own livelihood.
Source: STF, Theme 6 of general repercussion (RE 566,471), Theme 1,234 (RE 1,366,243) and Binding Precedent 61. When the annual cost of treatment reaches 210 minimum wages, the action against the Federal Government goes to the Federal Courts.
What is your case?
Situations the firm handles
Chemotherapy and targeted therapy
Cancer drugs prescribed by the doctor and denied or delayed by the SUS, with a request for an injunction when there is risk.
STF Themes 6 and 1,234Listed medicine not delivered
Medicine that is on the SUS lists but is out of stock at the pharmacy or at CEMAC Juarez Barbosa.
Liability of the public entityCannabis-based products
Request with a medical report, Anvisa authorization and proof of previous treatments.
Review of the specific caseBiologic drugs
Medicines for multiple sclerosis, severe asthma, inflammatory diseases and immunodeficiencies.
STF Theme 6Delay by the Health Department
A filed request with no reply within a reasonable time can also be taken to the courts.
STF Theme 1,234People with a health plan
When it is the health plan that denies it, different rules apply. See the path.
Law 9,656/1998Step by step
How the firm works
- Review. We check whether the drug is on the SUS lists, whether it is registered with Anvisa and which body must provide it.
- Documents. We guide the doctor on what the report needs to include and organize the denial, prescriptions, tests and quotes.
- Request. Request to the Health Department or a lawsuit with a request for an injunction, depending on the case.
- Follow-up. NatJus technical note, enforcement of the decision and renewal of prescriptions during treatment.
Case review
Let's review your case
Answer the questions, one at a time. At the end you can attach documents, which go straight to a folder in the firm's Drive, and send the summary via WhatsApp. Everything is protected by attorney-client confidentiality.
Common questions
Frequently asked questions
Do I need to request the medication from the SUS before going to court?
Yes. The STF requires an administrative request and its denial, or the lack of a response. Keep the protocol number and any written response from the Health Department or the high-cost pharmacy.
What must the medical report include?
Diagnosis with ICD code, treatments already tried and their results, why the SUS medicines are not suitable, the name of the medicine, the dose, the length of use and the risk of waiting. A complete report makes a big difference in the NatJus technical note.
How long does it take?
In urgent cases, an injunction can be requested. NatJus Goiás has up to 24 hours to respond in urgent cases and up to 20 days in other cases, under the unit's Ordinance 01/2025. How long the decision takes depends on the judge.
Is the lawsuit against the State, the municipality or the Federal Government?
It depends on whether the medicine is on the SUS lists, on who is responsible for it and on the annual cost of treatment. The firm carries out this analysis before filing the lawsuit.
What if the medicine is not registered with Anvisa?
As a rule, the courts do not order it to be provided. There are narrow exceptions that require a specific review of the case.
Is a prescription from a private doctor valid?
It may be valid, as long as the report is complete. Some judges also ask for an assessment by a SUS doctor.
How much does it cost?
After the analysis, the firm sends a written fee proposal before any engagement.