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Um ano depois de definir a questão, o Superior Tribunal de Justiça (STJ) voltou a discutir o fornecimento de medicamentos não listados no rol da Agência Nacional de Saúde Suplementar (ANS). O tema está na pauta dos ministros em razão da entrada em vigor da Lei nº 14.454, de 2022, que estabeleceu pré-requisitos para a concessão de tratamentos não aprovados pelo órgão.
A questão é importante porque, segundo especialistas, a nova norma facilitaria a concessão de pedidos. Por enquanto há apenas o voto da relatora, ministra Nancy Andrighi, negando os pedidos dos planos de saúde para não ter que arcar com exames e tratamentos. O julgamento, iniciado ontem, foi interrompido por pedido de vista do ministro Villas Bôas Cueva.
Dois dos três recursos julgados são da São Francisco Sistemas de Saúde. Em um deles, ela contesta decisão do Tribunal de Justiça de São Paulo (TJSP) que a condenou a custear o exame Pet Scan para beneficiária com câncer colorretal, além de pagar indenização por danos morais de R$ 5 mil (REsp 2037616). No outro, questiona tratamento ocular quimioterápico a paciente diagnosticada com neoplasia pleural e retinopatia diabética, também determinado pelo TJSP (REsp 2057897).
No terceiro recurso , a Hapvida contesta decisão do Tribunal de Justiça do Amazonas (TJAM) que a condenou ao fornecimento do medicamento Rituximab, destinado a paciente com Lúpus. A operadora alega, no recurso, que a medicação tem natureza experimental e que, embora esteja no rol da ANS, tem a ressalva de que deve obedecer às Diretrizes de Utilização (DUT) estipuladas pela Anvisa (REsp 2038333).
No julgamento, os advogados dos planos de saúde destacaram que os processos são anteriores à nova lei e que a norma não poderia ser aplicada de forma retroativa. Ana Tereza Basílio, que assessora a São Francisco Sistemas de Saúde, defendeu, em sustentação oral, a volta das ações ao TJSP para aplicação do precedente do STJ, de junho de 2022, que considerou o rol taxativo, com exceções.
Hugo Mendes Plutarco, advogado da Hapvida, afirmou, na sequência, que a nova lei manteve a taxatividade do rol da ANS e que o custeio de medicamento e tratamento fora da lista não seria autoaplicável.
Último a falar, o advogado André Menescal Guedes, que também assessora a São Francisco, destacou que a nova lei foi uma complementação necessária ao julgamento do STJ, e trouxe novos requisitos.
Este trecho é parte de conteúdo que pode ser compartilhado utilizando o link https://valor.globo.com/legislacao/noticia/2023/08/23/stj-volta-a-julgar-fornecimento-de-medicamento-fora-do-rol-da-ans.ghtml ou as ferramentas oferecidas na página.
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