What are Brasíndice and Simpro?
Brasíndice and Simpro are private publications that compile prices for drugs and health products in Brazil. Hospitals and health plans (operadoras) use them as market references to value items on the hospital claim. Neither is a government table: they only apply to the claim when the contract between hospital and health plan adopts them. The closest US analogy is a mix of a chargemaster and drug pricing compendia, but the logic is different: the price is set by contract over a third-party publication.
Simpro publishes the Revista Simpro Hospitalar, which the publisher presents as a maximum-price reference for drugs and health products, used in billing, claim review, quotes and tenders [2]. According to the publisher, the information is the sole responsibility of the advertisers (manufacturers, importers and distributors), with no influence from the magazine on how prices are set [2]. For products, it lists the factory price current at the date of the latest survey; for drugs, prices come from company price lists and are compared with those published by Anvisa (the health regulatory agency) [2]. Each edition states its validity period [2].
Brasíndice is another private price publication that contracts may adopt as a reference.
This guide is part of the Hospital billing topic: supplies and drugs are one of the claim lines that weigh most on revenue.
Code, ceiling and reference: three different things
Pricing an item on the claim involves three layers, each with its own owner.
| Layer | Who defines it | What it provides | What it does not provide |
|---|---|---|---|
| Code (TUSS) | ANS (the National Supplementary Health Agency), sourced from Anvisa and, for drugs, also CMED [3] | Table 19 (supplies and OPME) and table 20 (drugs); code, term, description and validity [3] | Price: a TUSS term has no value field [3] |
| Regulated ceiling | CMED (Law 10,742/2003) [6] | Drug PF and PMC, with annual adjustment [5][6] | Supply prices; contract markup |
| Market reference | Private publisher (Brasíndice, Simpro) or the parties (own schedule) | Price per item and presentation, per edition | The application rule: the contract decides |
In practice, a hospital can have the right TUSS code (Unified Terminology for Supplementary Health) and the right magazine price and still bill wrong, because it applied the wrong contract rule. The TUSS code table guide explains how to look up codes.
PF and PMC: which price applies to drugs?
CMED Resolution 3/2009 (Resolução CMED nº 3/2009) defines the Manufacturer Price (PF) as the ceiling at which a laboratory or distributor may sell a drug in Brazil, and the Maximum Consumer Price (PMC) as the retail ceiling, that is, pharmacies and drugstores [5]. CMED was created by Law 10,742/2003, which set the ceiling model with annual adjustment [6].
Article 3 of the same resolution prohibits publishing a PMC, in any medium, for a drug whose registration defines it as restricted to hospitals and clinics [5].
The effect on the claim: if the contract says all drugs are billed “at PMC”, there will be no published PMC for hospital-only drugs. Without a written rule for that group, each side applies its own reading and the item tends to become a dispute. The fix is for the contract to state, by group, which ceiling applies and what to do when it does not exist (for example, PF plus a defined percentage).
What the contract needs to define
Law 9,656/1998, art. 17-A, § 2, II, requires the contract between health plan and provider to state service values, adjustment and billing and payment deadlines [4]. For supplies and drugs, “value” may not be a fixed number but a rule that points to a publication. That rule must answer seven questions.
| Decision | Question | Example wording to record |
|---|---|---|
| 1. Publication | Which reference applies to each group? | Brasíndice for drugs, Simpro for supplies, own list for diets and gases |
| 2. Edition and base date | Which edition applies to the claim? | The one valid on the date of service (or discharge, or submission); deadline to adopt a new edition |
| 3. Price type | PF, PMC or product factory price? | PF for all drugs; specific rule for hospital-only drugs with no PMC [5] |
| 4. Discount or markup | What percentage applies to the reference? | Discount or markup by group, with validity and adjustment rule |
| 5. Fractioning | Bill the fraction used or the whole package? | Fraction for multidose vials; package for single-use items |
| 6. Unit of measure | In which unit is the item billed? | Same unit as the adopted publication; defined conversion for tablet, ampoule, mL |
| 7. Own schedule and unlisted items | What applies to items not in the reference? | Own list attached and versioned; substitute reference or quote with invoice |
Two notes. Contract adjustment and a new magazine edition are different events, and both must be in the master data with dates. And items included in fees, bundles or the procedure should not be priced separately: their composition must be attached to the contract. The Hospital–health plan contract guide covers the other clauses.
See the steps as a list
- Item — usage record (prescription, nursing check, OR sheet)
- Code — ANS TUSS: table 19 (supplies) or 20 (drugs)
- Reference — publication and edition: Brasíndice, Simpro or the health plan's own schedule
- Rule — set in the contract: PF or PMC, discount or markup, fractioning, unit
- Claim line — TISS form: table code, item code, quantity, unit and total value
How the price becomes a TISS claim line
On a claim sent under the TISS standard (the ANS electronic data interchange standard), each supply or drug is a line with, among other fields, the reference table code, the item code, quantity, unit of measure and values..
The table code tells where the item code comes from: 19 for supplies, 20 for drugs, or a health plan's own table. TISS allows own code tables (tables 00, 90 and 98, up to 10 characters) for terms not yet in TUSS, but forbids keeping them once the term enters TUSS and the implementation deadline passes [3]. In TUSS version 202607, table 87 (domain tables) lists 00 “Tabela própria das operadoras” (health plan's own table), 90 “Tabela Própria Pacote Odontológico” (own dental package table) and 98 “Tabela Própria de Pacotes” (own package table), plus 18, 19, 20 and 22 for TUSS terms; the unit of measure follows table 60, such as 001 (AMP, ampoule) [7].
Note the two kinds of “own table”. An own price schedule is the list of values negotiated in the contract instead of a publication. An own code table is the health plan's coding for items with no TUSS code. One does not imply the other: an item can have a TUSS code and an own-schedule price.
The TISS claim forms guide explains which form each item goes on.
Pricing errors to avoid
These errors come from master data and calculation rules, and all can be caught before submission. The denial codes each one may trigger are in the Supplies and drug denials guide.
| Error | How it happens | Prevention |
|---|---|---|
| Outdated or early edition | Master data switches edition on a date other than the contract rule | Base date written in the contract; edition history in the system |
| Wrong ceiling | Drug valued at PMC when the contract says PF, or vice versa | Rule by group, including hospital-only drugs |
| Another contract's percentage | One plan's discount or markup applied to another | Percentage by health plan, group and validity |
| Package instead of fraction | Whole vial billed when the contract pays the dose | Fractioning rule in contract and master data |
| Unit mismatch | Publication price per box, quantity entered per unit | Unit conversion per item |
| Wrong presentation | Price of another strength or manufacturer | Link stock item ↔ presentation in the publication |
| Unlisted item | Item missing from own schedule, billed at a loose price | Clause with substitute reference or quote |
| OPME priced as a regular supply | Special device billed under supply rules | Classification checked by the OPME team (see OPME denials) |
Who owns pricing in the hospital?
Supply and drug pricing spans three areas. Procurement and pharmacy keep the link between stock item and publication presentation. Contracts translate each clause into parameters (publication, edition, ceiling, percentage). Billing checks the claim before submission. When no one owns the edition switch, it may happen too late or too early.
What we see in operations
At Accrua, the price of every supply and drug is checked against the contract, not against the reference publication on its own. Accrua OS has, per health plan, the contracted table, the pricing rule (PF, PMC or the plan's own table), the edition of the reference that applies to that contract and the denial history for that item. Before submission, every line of the claim is checked against those rules.
The alerts that matter most come up when the hospital's item master uses a different edition from the one in the contract, when the pricing rule applied is not the one agreed, or when a hospital-only drug is billed at a price that does not apply to it. Correcting an item that changes the value is the biller's or auditor's decision, with the clause in view.
When the same gap keeps coming back, the fix goes to the source: the hospital's price master, or the clause the hospital can take to its next negotiation.
Where to start
- List your contracts and answer the seven decisions in the table above for each. A gap is a clause to negotiate.
- Set up the system with publication, edition, ceiling and percentage by health plan and group, always with validity dates.
- Link each stock item to the presentation and unit in the adopted publication.
- Name an owner for the edition switch and the date it enters master data.
- Check claims before submission with rules for prices above the reference and for unlisted items.