Abstract
Introduction (with the objective): The financing of hospital pharmaceutical care faces the challenge of balancing the expansion of access, the incorporation of high-cost technologies, and the judicialization of healthcare, which frequently consumes the regular budget to meet individual demands. At the HUPES Complex, a gap was identified in the continuity of care and in the provision of non-standardized technologies, requiring a restructuring of local financing. To mitigate this problem and ensure equity, a plan was developed to expand the budget focused on patients involved in legal proceedings, intra-hospital registration for the Specialized Component of Pharmaceutical Assistance (CEAF), and the incorporation of new technologies through the expansion of its own budget. OBJECTIVES: To report the innovation in the management process and budget expansion of the Pharmacy Sector of the HUPES Complex, through an agreement with SESAB, aiming to increase the population's access to high-impact therapies, support for patients involved in legal proceedings, and reduce bureaucracy in accessing the CEAF. Description: METHODS: This is an Innovation and Quality Improvement Report, structured according to the SQUIRE 2.0 guidelines, describing the management intervention carried out in the Pharmacy Sector of the HUPES Complex from January 2023 to December 2025. The intervention was structured around three areas of agreement with SESAB (Bahia State Health Secretariat): 1) Expansion of patient reception for those with court orders for medications acquired through state procurement; 2) Integration of the patient registration workflow in CEAF (Center for Pharmaceutical Assistance and Training) during hospitalization or shortly after discharge, ensuring continuity of treatment; 3) Allocation of local budget for the incorporation of high-impact clinical technologies not yet available in routine practice, with continuous evaluation and support from the Pharmacy and Therapeutics Committee and the Health Technologies Center. The evaluation was based on pre- and post-intervention financial indicators, analyzing the change in the financial volume of each funding source. RESULTS: Direct agreement allowed for the transition of funding, mitigating the unplanned budgetary impact. A total of 608 judicial patients were admitted between 2023 and 2025, whose care is covered by state funding, generating an annual budgetary increase from R$45,384,212.71 (2023) to R$70,589,415.47 (2025), or 55.54% during the period. Regarding CEAF, early registration in the hospital setting reduced post-discharge waiting time, ensuring a safe transition of care and an annual budgetary increase from R$21,828,989.16 (2023) to R$57,204,307.57 (2025), representing a 162.06% increase. The local budget increase resulted in the immediate incorporation and availability of new high-impact technologies, whose acquisitions were consolidated rapidly, with a sustainable increase in access for the population served by the complex, with an annual budget increase from R$12,129,321.51 (2023) to R$18,173,643.38 (2025), representing a 49.83% increase. Trend analysis over 36 months demonstrated the consolidation and reproducibility of the agreement model. Conclusion: The budget restructuring through an agreement with SESAB proved to be a highly effective management innovation. The strategy not only expanded access to high-cost technologies and resolved bottlenecks related to litigation, but also integrated the flows of the specialized component into the hospital routine, strengthening pharmaceutical care as a central axis of patient care.
