The National Council of Social Security (CNSS) has detailed a significant expansion in the high-cost coverage of the Subsidized Regime of the Family Health Insurance. Through Resolution No. 631-04, issued on February 26, 2026, medications are being incorporated to treat non‑oncological pathologies, a key step to assist the most vulnerable sectors of the Dominican population.
Details of the high-cost coverage
This measure addresses the need to treat chronic and complex diseases that require expensive drugs, excluding oncological ones already covered in previous schemes. The high-cost coverage includes treatments for conditions such as rare diseases, hematologic disorders, and severe rheumatic pathologies, according to official specifications from the CNSS. This expansion directly benefits more than 2.5 million affiliates of the Subsidized Regime, which represents 40% of the insured population in the Dominican Social Security System.
Historical context of the Subsidized Regime
Since its creation in 2002 under Law 87-01, the Subsidized Regime has evolved to progressively include services of high-cost coverage. In 2023, increases of 15% in consultations and hospitalizations were reported, driven by demands for health equity. Experts from the Dominican Medical Association highlight that this resolution strengthens access, although they warn about logistical challenges such as distribution in rural areas.
Identified benefits and challenges
- Expanded access: Medications now available in authorized SFS pharmacies, reducing out‑of‑pocket expenses by 70% for eligible patients.
- Requirements: Affiliates must present diagnoses certified by specialists to activate the high‑cost coverage.
- Key statistics: In 2025, spending on high‑cost medications exceeded RD$5,000 million, with projections of a 20% increase this year.
Authorities of the CNSS emphasize that this high-cost coverage seeks to align the system with international standards, such as those of the WHO, which recommend universal inclusion for non‑communicable diseases. However, patient associations demand greater transparency in the list of approved drugs and faster processing, which currently takes up to 30 days.
This Subsidized Regime initiative not only eases economic burdens, but also promotes the system’s sustainability. The CNSS announces periodic reviews to incorporate therapeutic advances. In the Dominican Republic, where 30% of the population lives in poverty, the high-cost coverage represents a concrete step toward health justice, with a direct impact on the quality of life of thousands of families.
