Title: From Litigation to Policy Action: Oncology Pharmaceutical Care as a Strategy to Reduce Inequalities in Brazil

Background
In low- and middle-income countries (LMICs), translating cancer research into equitable public health action remains a major challenge, particularly in the context of high-cost oncology medicines. In Brazil, historical delays in the incorporation of innovative cancer therapies into the Unified Health System (SUS) have contributed to health litigation as an informal access pathway, especially for patients with advanced colorectal cancer. This process has revealed structural weaknesses in oncology pharmaceutical care, including fragmented access, territorial inequities, and limited governance over the use of high-cost medicines. While litigation may ensure individual access, it undermines equity, sustainability, and integrality of care, highlighting the need for structured pharmaceutical policy responses.

Methods
A retrospective descriptive study was conducted using secondary data from 351 successful judicial cases requesting monoclonal antibodies (bevacizumab, cetuximab, and panitumumab) for metastatic colorectal cancer in Minas Gerais, Brazil, between 2009 and 2016. Sociodemographic, clinical, economic, and territorial variables were analyzed to assess access pathways, treatment settings, costs, and geographic displacement. Findings were interpreted through an implementation research perspective to inform public health action.

Results
Judicialization predominantly benefited patients with advanced-stage disease who frequently traveled long distances to access treatment in high-complexity oncology centers. A substantial proportion had private health insurance and received care in private clinics, revealing hybrid public–private access mediated by the judiciary. Individual court decisions enabled access to high-cost therapies but were not extended to other patients with similar clinical conditions, reinforcing inequities and fragmenting pharmaceutical care.

Public Health Implications and Conclusion
Health litigation reflects structural gaps in oncology pharmaceutical policy implementation rather than a sustainable access strategy. Evidence from this study directly informed the creation of the Pharmaceutical Care in Oncology Component (AF-ONCO), established by Ordinance GM/MS No. 8,477/2025. AF-ONCO represents a capacity-building, evidence-based policy that translates research into action, strengthens pharmaceutical care governance, and promotes more equitable and sustainable access to oncology treatments in LMICs.

Keywords
Pharmaceutical care; Health litigation; Oncology policy; Implementation research; Low- and middle-income countries; Brazil.

Acknowledgements: (In memoriam) Francisco de Assis Acurcio, mentor, co-author, and reference in pharmaceutical care research, whose legacy continues to inspire this work.