Controversy Between the Colombian Ministry of Health and Health Insurance Giant Sanitas

Another chapter unfolds in the crisis of the Colombian Health Insurance Company (EPS) Sanitas. In recent hours, there has been controversy between the insurer and the Ministry of Health regarding a debt that jeopardizes the supply of medication starting from mid-November. The pharmaceutical company that supplies drugs to Sanitas’ policyholders, Cruz Verde, warned that if the health insurer does not pay the 400 billion debt it owes to the pharmaceutical group, medication delivery to patients would be stopped within fifteen days.

Both the Colombian opposition and the health insurer have pointed fingers at the government for the debt, citing delays in the disbursement of public funds that underpin the healthcare system in Colombia. However, Health Minister Guillermo Jaramillo responded to these allegations by stating that his ministry has disbursed every peso committed by the state for medication payments to Sanitas.

Sanitas clarified that they have indeed received the money but explained that the state’s debt to them, which prevents them from paying the pharmaceutical company, has been a longstanding issue dating back to 2020. Over the course of three years, this discrepancy in payments has accumulated to the 400 billion that Cruz Verde is now demanding.

Opposition Accusations

Members of the opposition party, Democratic Center, have made harsh accusations against the minister and the government, claiming that officials are playing with the health of Sanitas policyholders to advance the healthcare reform agenda that the government is currently pursuing in Congress. However, the president of Sanitas has revealed that the state’s debt to the health insurer goes back three years, precisely during the government of President Duque, a Democratic Center politician.

Minister Jaramillo’s Response

Health Minister Guillermo Jaramillo responded to the harsh accusations against his administration and the government. Jaramillo defended the assertion that payments committed to Sanitas for medications not included in the Health Benefits Plan (No PBS) are current.

“Sanitas is one of the health insurers receiving the most through the Unit Payment by Training (UPT), and, furthermore, one of those receiving the most Maximum Budgets. In other words, they receive ample financial support. To put it in perspective, they owe 829 billion pesos to just 27% of public hospitals,” clarified the minister.

Jaramillo emphasized that they are up to date on all payments to Sanitas until October, including Maximum Budgets and the UPT. He specified that they have paid 5.7 trillion pesos for the contributory regime and 1.6 trillion pesos for the subsidized regime, as well as 492 billion pesos for Maximum Budgets.

“So, they cannot claim any debt. What needs examination is why they owe 400 billion to Cruz Verde and 900 billion pesos to 27% of public hospitals. There will likely be other suppliers who they owe as well. Currently, we are gathering information to determine the extent of their indebtedness to the system,” the minister concluded.

Sanitas’ Defense

Juan Pablo Rueda, the president of the health insurer Sanitas, spoke out later to clarify the minister’s statement. Rueda acknowledged that the government is current with payments, as announced by the Health Minister. However, he clarified that the debt with Cruz Verde has accumulated over the past three years.

According to their calculations, the cost of providing medications that do not belong to the Health Benefits Plan (No PBS) for their policyholders amounts to 55 billion per month, whereas the government is only recognizing 32 billion. This difference, from 2020 until today, would have resulted in the 400 billion debt demanded by Cruz Verde from Sanitas.

“We have made every effort for the government to understand these figures. They are aware of them. But the State has a financial responsibility in this matter. There has to be recognition of that debt and an effective payment,” Rueda stated, promising to seek a solution in the coming days to ensure the uninterrupted supply of medications to their policyholders.

Rueda clarified that the first negotiations to ensure the continuity of the medication system will be conducted with the pharmaceutical company. He also blamed the media for the social alarm created by Cruz Verde’s announcement of the suspension of medication supply. Rueda emphasized that the pharmaceutical company has guaranteed the continuity of Health Benefits Plans medications, while it is the medications not included in that plan that are at risk. “No PBS technologies account for 20% of the total billing we have with Cruz Verde,” Rueda pointed out.

In this regard, the insurance executive said that the government’s plan to inject 90 billion will alleviate Sanitas’ financial system but will not fully resolve it. To find a quick solution, Rueda proposes transferring a significant portion of NO PBS medications to the Health Benefits Plan (PBS). Similarly, Rueda, the top executive of Sanitas, said that another solution is the government making direct payments to pharmaceutical companies, as provided in the healthcare reform project currently being discussed in Congress.