The implementation of the Farmácia Popular do Brasil program (PFPB) in 2004 introduced a third source of medicines provision, the other two being the Pharmaceutical Services in Primary Health Care (AFAB) and the retail pharmacies. PFPB introduced new mechanisms, such as the subsidies, the copayment and the public private partnership (PPP) with the retail pharmacies, in the Aqui Têm Farmácia Popular (ATFP) modality, the main one considering investiments and number of facilities. Among the controversies about the program, an important one is the kind of relationship between the ATFP and AFAB, if competition or complementarity. This study aimed to analyze the relationships between ATFP and AFAB through the description and discussion of these policies in the broader context of challenges and disputes in the Unified Health System. The description of both policies was organized in three axes: services related, managerial related and political/economic/ideological features. Data systematization was guided by a matrix for each of the axes. A review of the scientific and technical literature was conducted, as well as consultation to publicly available secondary databases and official documents. It was found that, despite AFAB and ATFP having similar amounts of dispensing points, there is a larger number of cities covered by AFAB (higher than 90% against 77% in 2014), as well as their use as a source for obtaining drugs for hypertension and diabetes (45-60% in AFAB and 13-19% in ATFP, the remainder being obtained in the private sector). For other drugs, the private sector remains the main source of provision. Despite the higher coverage and utilization of AFAB, ATFP financing grew at an accelerated pace, particularly since the Saúde Não Tem Preço (SNTP) initiative, exceeding the amount allocated to AFAB even when added three federal spheres. The management models are different. The AFAB is based on the direct state management assumptions and has in structural and human resources problems as well as in programming, procurement and other logistics steps weaknesses. On the other hand, the PPP on ATFP makes the state exempted from the responsibilities cited for AFAB. However, the available evidence shows that this model is less cost-effective, once it involves outsourcing functions. The availability of drugs in the program is much higher, which can stimulate a possible intermittent migration of AFAB users to PFPB. Both policies show low qualification of pharmaceutical services offered, being the distribution of medicines the main focus and releasing patient care to a second plan. This panorama points out that a financial, political and symbolic priority is given to ATFP as a public policy. On the other hand AFAB maintains its deficiencies. Faced with the asymmetries between AFAB and ATFP, this work also examined the relationship of this process with political, economic and ideological issues that influences the health system trajectory. Some of them are: the role of the studied policies on the dynamics of health care models, focusing on demand segmentation, the tensions between selective and comprehensive primary health care models, health commoditization; underfunding and the different management models within the neoliberal context; the expansion of the pharmaceutical market and its relations policies for the Economic Industrial Health Complex (CEIS). From the perspective of consolidation of an universal and redistributive health care system, it is necessary a broad discussion about the direction of pharmaceutical policies in Brazil, as well as tackling the major structural issues that permeate the medicines provision, such as the high and regressive out-of-pocket spending, the low quality of pharmaceutical services, the poor regulation of private sector and the medicalization.
