What do we have and how do we have access to them in Latin America?

Abstract

In Uruguay, access to medicines and diabetes technology must be analyzed within the context of the National Integrated Health System (SNIS), established by Law No. 18,211. This system coordinates public and private healthcare providers under the stewardship of the Ministry of Public Health (MSP), with mandatory benefits defined in the Comprehensive Health Care Plan (PIAS). The system is financed through mandatory contributions from formally employed workers, employers, and the State, which are allocated to the National Health Fund (FONASA). The National Health Board (JUNASA) oversees healthcare providers' compliance with their management agreements.

The Therapeutic Formulary of Medicines (FTM) establishes the medicines subject to mandatory coverage, while the MSP defines health policies, standards, and healthcare quality guidelines.

The PIAS guarantees comprehensive care for people with diabetes, including diagnosis, follow-up, education, routine assessments, prevention of complications, nutritional and nursing support, ophthalmologic, cardiovascular, and renal evaluation, laboratory testing (blood glucose, glycated hemoglobin, oral glucose tolerance test [OGTT], lipid profile, renal function, blood ketones, urine ketones, albuminuria, and liver function tests), hospitalization, and emergency care.

Mandatory coverage includes blood glucose meters, test strips, medicines such as metformin, repaglinide, and sulfonylureas, regular and NPH insulin, supplies such as insulin pens and needles, and glucagon.

In 2025, pursuant to Decree No. 113/024, the basal insulin analogues glargine and detemir were added to the FTM for patients who meet specific eligibility criteria.

GLP-1 receptor agonists, dual agonists, SGLT2 inhibitors, DPP-4 inhibitors, rapid-acting insulin analogues, and second-generation basal insulin analogues are not included in the FTM; access therefore depends on out-of-pocket funding and institutional policies.

Decree No. 116/024 incorporated continuous glucose monitoring (CGM) into the PIAS for people with type 1 diabetes up to 21 years of age. For nonpregnant adults, access is not publicly funded.

The National Resources Fund (FNR), a non-state public institution, finances high-cost procedures, medicines, and technologies. It covers continuous subcutaneous insulin infusion (CSII) systems and their supplies from 2 to 21 years of age, according to the following indications: for individuals weighing less than 22 kg and/or receiving a total daily insulin dose below 10 IU, the MiniMed system; for those weighing 22 kg or more and/or receiving a total daily insulin dose of 10 IU or more, the Nano TouchCare system. In children younger than 2 years, each case must be assessed individually.

The FNR also administers CGM coverage for pregnant women older than 21 years with type 1 or type 2 diabetes who are treated with multiple daily insulin injections.

Uruguay's regulatory framework continues to evolve through parliamentary initiatives aimed at extending CGM coverage without an age limit and broadening access to insulin pumps and automated insulin delivery systems according to clinical risk criteria.

The main current gap lies in the availability of medicines with demonstrated cardiorenal-metabolic benefit and in the continuity of technology coverage once the established age limit has been exceeded.

Uruguay has access to innovation and technology; the challenge is to ensure sustainable, continuous, and equitable access.