Honduras is a lower-middle income country with a fragmented health system and less than US$100 per capita per year to meet its health needs. Within the framework of its commitment to Universal Health Coverage (CUS), the government decided to design a Health Benefits Plan (PBS). The design of the PBS was carried out in five steps. (1) An inter-institutional team from the Honduran Ministry of Health and the Social Security Institute defined the fundamental characteristics of the PBS. (2) Taking advantage of previous work carried out in the country, the universe of potential candidates for inclusion was identified. (3) Prioritization criteria and decision rules were discussed and operationalized. (4) A bottom-up approach was used to cost the PBS, with the current low coverage and with different objectives of improving coverage levels. (5) Fiscal impact analyzes were prepared and alternative paths of expansion were discussed with the government, proposing ethical criteria on the path towards UHC. The resulting PBS includes 74 essential health interventions. Given financial constraints, a progressive expansion path was suggested, whereby marginal increases in the health budget would be allocated to PBS. The design of a PBS is a specific process for each context; it includes several steps that go beyond the implementation of health technology assessment methods and requires a lot of technical and participatory work time and substantial pragmatism to adapt the technical recommendations of the literature to the data and time constraints in the field.

This policy brief is based on a webinar presented by Luis Alejandro Rivera, Chief of the Pricing Unit at the Dirección Nacional de Medicamentos (National Directorate of Medicines DNM) in El Salvador. The presentation was given on July 2019. Rising prices of medications are a global concern as healthcare expenditures soar and more patients are unable to access the medicines they need. El Salvador has managed to control and lower the price of prescription medicines for both innovator and generic medicines, while maintaining a well-functioning and cost-saving pharmaceutical market. This publication presents takeaways, such as price setting methods, the identification of appropriate market segments, and the introduction of online monitoring platforms, so that other policymakers may use them when introducing price regulation in their own pharmaceutical markets.

Health spending has been growing at a much higher rate than the income of countries practically all over the world. This increase is due to many factors such as the demographic and epidemiological transition, the increase in the expectations of the middle class and, mainly, the presence of more and better health technologies, such as medicines and medical devices. The case of Brazil does not escape the general rule. Expenditure on medicines increased by 40% from 2010 to 2015. Currently, this expenditure represents 16% of the public health budget. To face this challenge, the country has implemented pharmaceutical pricing policies among its strategies. This document presents the main strategies that the country has adopted, and the results achieved to date; highlighting the importance of regulatory designs aligned with the policy objectives and the local contexts.

This technical note discusses the application of economic evidence in health technology assessments for decision-making on the allocation of health resources. There is already recognition in Latin America that the economic dimensions of health interventions, such as cost-effectiveness and budgetary impact, are critical dimensions that should always be considered when making decisions about the coverage or inclusion of technologies in benefits packages. However, there are still barriers and constraints that prevent the evaluation of economic evidence in the region from being an integral part of all decision- making processes, with serious implications for the equity and efficiency with which health resources are allocated. The purpose of this technical note is to provide elements and tools that contribute, in a practical way, to overcoming these barriers, answering the questions asked by health systems that are beginning to apply economic evidence in their evaluation and decision-making processes. How do we know if a technology or intervention is cost- effective in our context? What cost-effectiveness threshold should be applied? How might non-economic criteria and dimensions influence our cost-effectiveness threshold? What limit should be considered when a technology implies a high budgetary impact in a particular health system? Given the existing difficulties in generating local economic evidence, what can the economic evidence generated in other jurisdictions tell us? How can economic evidence be taken into account in a fragmented health system? Consideration of these aspects is key to ensuring fairer, more transparent allocation of health resources and thus achieving more efficient and equitable health systems in Latin America.

This Breve first highlights the importance of pharmaceutical procurement policies. It then focuses on the goals of National Drug Policies. Based on these goals, it looks into the reasons for intervening in pharmaceutical markets and different forms of intervention. The subsequent sections analyze in further detail the procurement of in-patent and off-patent medicines, since there are fundamental differences in the procurement of these two medicine types. Finally, the Breve concludes by summarizing the most important issues for policymakers to keep in mind when defining procurement policies.

This Breve is based on the original thesis work and on a webinar presented by Dr. Fábio Ferride-Barros regarding the "Ethics of Health Resources Allocation in the Publicly Financed Health Care System in Brazil." The perspective offered in this Breve complements a previously published issue documenting the use of health technology evaluation in decision-making in Brazil's health sector (IDB, 2015). The Breve introduces the challenges of priority setting in the context of a large and decentralized national universal health care system, which confronts resource scarcity and substantial inequalities.

This Breve gives an overview of the characteristics of the pharmaceutical sector in Mexico and the main factors resulting in the decision to establish the CCPNM. It briefly discusses the legal framework of the Commission. Then, it looks at the CCPNM's objective and operations, before describingthe negotiation process. The results of the CCPNM in economic and organizational terms, as well as other positive impacts, are analyzed in the subsequent section. Finally, the Breve concludes by presenting some of the challenges emerging from the Mexican experience with its price negotiation scheme.

This Breve presents the story of how, in recent years, the Colombian health system has struggled with technological pressure. The impact of technological pressure on the health sector during the last few years could be summarized by either of two phrases: "the cost of success" or "the adverse consequences of technological pressure." This Breve describes how the inadequateincorporation of health innovations into the system can threaten an egalitarian-inspired reform that has brought social progress. The document also discusses the policy tools Colombia has introduced to face this
technological pressure. A commitment to strengthening the government¿s capacity to discern the value of health care innovations lies at the core of these policies.

The following Breve provides an overview of the main challenges that societies, health care systems, and policy makers are currently facing to confront cancer. This brief analyzes the main characteristics of cancer, and shows how these influence the development of new drugs. At the same time, it looks at some of the implications for patients. It also presents some thoughts on the pharmaceutical industry related to cancer treatments. Finally, it summarizes some policy lessons emerging from the analysis, and explains why basic research, better market regulation and a stronger focus on cancer prevention should be the main priorities to fight cancer in the future.