OSDE was convicted of failing to provide insurance coverage to a member suffering from multiple sclerosis

The Federal Civil and Commercial Court 2 thus represents an important precedent for defending members’ right to health.

12/07/2025 – 10:29 am

OSDE was forced to provide it by the judiciary 100% comprehensive coverage an expensive medication for a patient multiple sclerosisafter initially refusing the treatment prescribed by his doctor. The judgment of the Federal Civil and Commercial Court 2 sets an important precedent in defending members’ right to health.

The prepaid company had argued that the requested medication, Ofatumumab (Kesimpta)doesn’t integrate that Compulsory Medical Program (PMO) and that there was a therapeutic alternative. However, the patient, a young university student diagnosed in 2022, turned to justice after her condition worsened and her treating doctor reported it monoclonal antibody as the only “very highly effective” way to stop the progression of the disease.

OSDE was offered instead Cladribinea drug included in the PMO and currently covered, but the specialist warned that it is not suitable for this case. “Cladribine is not considered an appropriate option for this patient,” The neurologist noted that the one-year delay in completing the effects could put her at risk of reactivation of the disease and accumulation of disability.

OSDE, under the microscope: legal criteria and the right to health

In filings, OSDE claimed it had no legal obligation to provide coverage Ofatumumab because it is not in the PMO, and cited international reviews questioning its inclusion in the PMO high costs and the impact on the budget. However, the judge Marcelo Bruno Dos Santos He rejected these arguments and emphasized that the treatment prescribed by the specialist should take precedence over the opinion of the prepaid woman.

The judge found that Prepaid cannot replace a medical indication and that it is the treating professional who carries out the regular monitoring and is responsible for the diagnosis and the indicated treatment. Furthermore, he noted that the medical reports made it clear that the alternative offered by OSDE was not appropriate in this particular case.

Prepaid cover: Danger in the delay and the extent of the precautionary measure

The judge also emphasized that the young woman had already come forward new injuries and symptoms while we waited for approval, which showed the progression of the pathology. He explained this in this context Your right to health is affected and your life is at risksufficient evidence to demonstrate the risk of delay and to order precautionary measures.

That’s what the verdict said OSDE must immediately provide 100% of the specified medicationsuntil the final judgment is announced and as long as your treating doctor orders it, under threat of financial sanctions for non-compliance.

With this decision, the judiciary underlines the importance of giving priority to medical criteria and the right to health over the administrative limitations of advance payments, especially in cases of serious illnesses such as multiple sclerosis.