Federalism and primary healthcare access to medicines

Abstract Public Health is a fundamental social right, and the State is responsible for ensuring universal and equitable access through public policies. This duty is shared among the Federal Government, states, the Federal District, and municipalities, which hold legislative and administrative powers to safeguard health. With the creation of the Unified Health System (SUS), comprehensive care, including pharmaceutical therapy, became a guaranteed right. Intergovernmental coordination, through agreements and fund transfers, seeks to promote equity in access to medicines in Primary Health Care. Challenges related to funding, resource distribution, and the roles of each governmental entity still spark debates among managers and researchers. This article examines the advances and perspectives in access to medicines in Primary Health Care, discussing the combination of decentralization and centralization, along with cooperation among governmental entities, and its importance in ensuring universal and comprehensive access to Brazilian health services. Intermunicipal consortia, such as the Paraná Saúde Consortium®, exemplify successful solutions for coordinating access to medicines, showing the need for flexibility in addressing regional diversity and ensuring system comprehensiveness.