Introduction The Brazilian healthcare system is universal and provides pharmaceutical assistance. This paper investigates income disparities in public provision and out-of-pocket spending on medicines in Brazil.

Methods Prevalence of public provision was estimated using data from the National Household Sample Survey (PNAD-2008) (99% CIs). The mean spending of families on medicines (Brazilian Real-R$) and the proportion of this spending in relation to the family income were estimated using data from the Family Budget Survey (POF-2008/2009). Samples were divided in deciles of monthly family income per-capita.

Results Among people who had a drug prescription in the 2 weeks preceding the interview, 45.8% (45.5%–47.1%) received all or part of the medicines without paying, 62.9% (60.3%–65.4%) in the bottom income decile, and 15.8% (14.1%–17.7%) on the top. Among those who reported life-long use of medicines, 51.6% (51.1%–52.1%) received part or all without paying, 66.2% (63.9%–68.3%) in the bottom decile, and 17.8% (16.8%–18.9%) on the top. The mean monthly per-capita spending on medicines was R$4.42 in the bottom decile and R$58.11 on the top.

Conclusion While the public provision of medicines was about four times higher in the bottom decile than in the top and the out-of-pocket spending was 13 times higher in the top decile, the proportion of spending on medicines in relation to the family income was three times higher in the bottom decile. Although the public policy is equitative, the burden of spending on medicines is too high on poorer families.