In a landmark move to expand critical healthcare access for vulnerable populations, the Dominican Republic has formally greenlit the High Cost Medicines Fund (FOMAC), an initiative led by the Superintendency of Health and Labor Risks (Sisalril) that will provide full, out-of-pocket-free coverage for life-saving treatments for people living with complex and catastrophic illnesses.
Under the new framework, individual patients will be able to access comprehensive essential therapies costing between 2 million Dominican pesos (RD$) and RD$16 million per year, with 100 percent coverage, zero co-payments, and no annual coverage caps for an initial roster of 13 high-cost medications. The approved drug list includes Ribociclib, Palbociclib, Pembrolizumab, Adalimumab, Etanercept, Golimumab, Infliximab, Tocilizumab, Ustekinumab, Blinatumomab, PEG-Asparaginase, Octreotide and Risdiplam. These therapies address a wide range of severe and life-altering conditions: multiple types of cancer including breast cancer, lung cancer, and several pediatric cancers (acute lymphoblastic leukemia, Hodgkin lymphoma, retinoblastoma, Wilms tumor, low-grade glioma, and Burkitt disease), along with chronic autoimmune conditions such as rheumatoid arthritis, psoriasis, and Crohn’s disease, as well as acromegaly and spinal muscular atrophy.
During an official press conference, Dominican Minister of Public Health Víctor Atallah and Sisalril director Miguel Ceara Hatton outlined the core goals of the program: to strengthen health safety nets for affiliated residents, ensure uninterrupted access to life-sustaining care, and slash the crippling out-of-pocket medical costs that push thousands of families into financial hardship during their most medically vulnerable moments. Officials project that the program will directly benefit roughly 6,447 people living with these conditions, including both previously diagnosed patients and newly detected cases.
Beyond expanding access, FOMAC is designed to ease strain on the existing public high-cost treatment system. The Ministry of Public Health’s current High Cost Medication Program, which currently serves 8,468 patients, maintains a waiting list of 4,950 people seeking access to the 13 drugs now covered by FOMAC through the Family Health Insurance (SFS) system.
The National Social Security Council (CNSS) gave final approval to the initiative recently, confirming that the program will be funded entirely through existing SFS resources. Crucially, the new coverage will not increase insurance costs for workers or their immediate dependents, nor will it require any special extraordinary contributions from participating employers. The program also benefited from early input and buy-in from leading patient advocacy groups representing people living with complex and catastrophic illnesses, whose representatives took part in the working groups organized by Sisalril to develop and refine the policy.
A key structural feature of FOMAC is its centralized drug purchasing model, which will leverage bulk purchasing power and economies of scale to drive down system-wide costs. Officials estimate that this mechanism will cut total program costs by approximately RD$6 billion, making the initiative fiscally sustainable without tapping additional public or participant funds.
FOMAC is on track to become fully operational within 12 months, a timeline that allows for required capitalization and logistical preparation for the new program. Moving forward, Sisalril will retain regulatory and oversight responsibility for FOMAC’s implementation, aligned with its existing governance authority under the Dominican Social Security System (SDSS).