Chile’s 2027 budget cuts Ricarte Soto high-cost drug line by 14% in real terms

POLICY & MARKETS · HIGH-COST DRUGS · OCTOBER 7, 2026 · CHILE

Chile’s 2027 budget bill, sent to Congress on 30 September, gives the Ley Ricarte Soto, the state scheme that pays for high-cost treatments for 27 conditions, 166,951m Chilean pesos (CLP), down 14.45% in real terms on 2026. For makers of cancer, immunology and rare-disease drugs, the line signals a payer with less room to add anything new.

A cut inside a growing health budget

The reduction stands out because health gets the budget’s biggest increase in pesos. According to the breakdown the Dirección de Presupuestos (Dipres), the finance ministry’s budget office, presented to Congress on 6 October and reported by Emol, the health ministry’s allocation rises by CLP 829,568m, or 4.7% in real terms, to CLP 18.3trn. The Ricarte Soto line, which Fonasa (Fondo Nacional de Salud), the public insurer, administers, moves the other way. In nominal terms it falls from CLP 189,696m in the 2026 budget law to CLP 166,951m, 12% less.

Daniela Sugg, a health economist, told The Clinic the reduction comes without declared reasons, such as a renegotiation, fewer patients or therapies moving into the GES (Garantías Explícitas en Salud) benefit package. May Chomali, health minister in the government of President José Antonio Kast, called the cut “technicalities” and told T13: “No patient who needs a medicine included in the Ricarte Soto law, for all the conditions that are covered, will be without their medicine” (translated from Spanish). She added that the law “arrived underfunded” because patients were surviving longer than expected.

The budget line need not be a hard ceiling. Ms Sugg notes the item is “exceedable”, meaning Fonasa can spend more than the budget law says; the 2026 budget’s own rules require Fonasa to report quarterly on the decrees that authorise such overspending. But she also called the cut “a delicate signal” that “should worry us” (translated from Spanish), because it breaks with efforts to budget for expected spending.

Demand has outrun the fund

The numbers explain the worry. Cumulative beneficiaries have risen from 51 in 2015 to 75,232 in 2025, according to Ms Sugg’s analysis, and from about 57,000 in 2023, a rise of roughly a third (75,232 / 57,000 − 1 = 32%). Juan Luis Castro, the Socialist senator who chairs the Senate health committee, puts current enrolment at 84,000.

None of this is new to the Treasury. A Chamber of Deputies health committee report records that in 2021 Dipres warned the fund “would cease to be sustainable in 2027” (translated from Spanish). The scheme has covered the same 27 conditions since 2019, The Clinic notes. A bill sent by the previous government of Gabriel Boric (bulletin 17,567-11) to raise the fund’s permanent fiscal contribution from CLP 100,000m to CLP 185,000m a year, an 85% increase, and lift the cap on expected annual costs from 80% to 90% of the fund’s budget, passed the Chamber of Deputies unanimously on 28 January 2026 and is now before the Senate.

What suppliers should read into it

For manufacturers, the line matters less as an immediate payment threat than as a signal on market entry. Incorporation of new conditions has been paused since 2021 for lack of funding, so new therapies have few routes in. The pending bill also carries provisions industry watches: explicit rules for risk-sharing agreements bought through Cenabast (Central de Abastecimiento), the state procurement agency, and an obligation to publish the precio máximo industrial (PMI), the maximum manufacturer price, for each covered technology.

The courts, the other side door, are narrowing. Fonasa spent almost CLP 80,000m in 2025 on high-cost drugs ordered by court rulings, nearly triple the CLP 28,914m initially budgeted, The Clinic reported (80,000 / 28,914 = 2.8x). La Tercera reported in July that the Supreme Court now tends to reject such claims after a change in its composition. Francisca Rodríguez of the Cámara de la Innovación Farmacéutica (CIF), the innovative-drug makers’ association, told the paper that through litigation the state “cannot negotiate a better price based on the value of the medicine” (translated from Spanish). Mr Castro argues that guarantees on paper will not hold in practice: “on paper, of course, people are covered”, but “the cut is very big, they will not have the same coverage, it is impossible” (La Tercera, translated from Spanish).

Our expectation: the government will restore at least part of the CLP 28,208m through an amendment before the budget passes, because Congress, which under the constitution can cut but not add spending, has objected across party lines, and the sum is small against a health budget rising by CLP 829,568m. Restoring the money is unlikely to reopen the scheme to new conditions: Dipres has told legislators new treatments can be added only if they generate net savings, and the bill to change the fund’s financing has yet to clear the Senate.

Why this is relevant

Update, 15 October 2026: an earlier version said bill 17,567-11 had been stalled since March; it passed the Chamber of Deputies in January and is before the Senate. We have also removed a figure on 2026 budget execution that we could not re-verify.

Sources: Cámara: 2027 budget bill, Tesoro Público · Senado: guide to the budget process (Art. 67) · The Clinic: Ricarte Soto cut (6 Oct 2026) · El Rancagüino: Senator Castro on the cut · El Dínamo: 2027 budget cuts · T13: Minister Chomali responds · La Tercera: Castro interview (7 Oct 2026) · Emol: 2027 budget by ministry · MediaInfo: budget bill submitted 30 September · Biblioteca del Congreso Nacional: Fonasa 2026 budget · Dipres: Fonasa 2026 budget and glosas · Chamber of Deputies: health committee report on Ricarte Soto bills · La Tercera: court-ordered drug spending (7 Jul 2026) · The Clinic: Fonasa court-ordered spending in 2025