THE EFFECTIVENESS OF SUPREME COURT RULING 1234 IN THE JUDICIALIZATION OF MEDICINES: BUDGETARY AND ADMINISTRATIVE IMPACTS ON PUBLIC HEALTH MANAGEMENT IN THE LEGAL AMAZON

Abstract

The judicialization of health, characterized by the pursuit of the fundamental right to health through lawsuits, has generated significant impacts on the budget of federative entities, compromising the planning and execution of public policies by the Unified Health System (SUS). This article analyzes the efficacy of Theme 1234 (RE 1.366.243) of the Supreme Federal Court (STF), which established new guidelines for the supply of medicines, set jurisdictional competencies based on the cost of treatment, and determined rules for interfederative funding and reimbursement. Focusing on the Legal Amazon region and a case study directed at the public administration of the State of Rondônia (State Secretariat of Health - SESAU-RO and State Attorney General's Office - PGE-RO), the research investigates whether the new regulatory framework has a real aptitude to mitigate state financial imbalance. The methodology adopted is qualitative and documentary, based exclusively on the analysis of current regulations, government official letters, administrative processes, and actually produced correlated bibliography. The State of Rondônia, as a federative entity, has seen a high number of lawsuits related to the provision of high-cost medications in its administrative history. This situation falls under the regulations of Theme 1234, which allows subnational entities the right to claim reimbursement from the Union. However, the internal structure of the departments responsible for complying with court orders, combined with an outdated method of management and data processing, is a significant obstacle to ensuring that the benefit is delivered on time. Overcoming bureaucratic and technological barriers is essential for the state to turn health-related litigation into efficient management, ensuring the reimbursement owed and promoting a more equitable use of public resources.The results indicate that, although Theme 1234 creates a rigorous legal framework capable of protecting the state treasury — notably through the parameterization of values in the Maximum Government Sale Price (PMVG) and the mechanisms of reimbursement by the Union —, its material efficacy depends directly on administrative restructuring, data governance, and the integration between health secretariats and state attorney offices for effective collection and procedural redirection.