Discussing the judicialization of health in Brazil is a relevant, albeit very complex, issue, especially regarding access to medication, since after decades of study, tracing a national profile is still a long way off. For example, there is a divergence in the literature regarding who seeks the judiciary requesting health services and products: poor or rich?. There is also a divergence concerning what they require: drugs and services that make part of the lists, protocols and contracts or not?. It even diverges on the effects of these lawsuits on the general policies of public and private healthcare: what is the magnitude of the disturbances caused? .
In order to fill a data gap in the Northeastern Region of Brazil, the present study has analyzed the lawsuits that have been filed against the State of Pernambuco. With an understanding that this was a convenience sample, it was not possible to address any trends that may have increased or reduced the impacts of these lawsuits on the state’s health management, although it was possible to describe the characteristics and behavior of expenditure on medications and the relevance of antineoplastic drugs in a Northeastern Brazilian state that ranks as one of the richest (GDP) in the region. The following comparisons with other findings in the literature have limitations, since the studies present different methodologies for collecting and describing the profile characteristics of judicialization, as recently cited by Oliveira et al.  (2021).
The profile of the judicialization of healthcare in the State of Pernambuco presented an approximately equal distribution of requests between the sexes, and there was no consistent difference, nor any pattern in other studies, seeing that, in the Brazilian Federal District (DF), Diniz et al.  identified 51% of males. However, females were more prevalent in the states of Minas Gerais, with 60.2% , Ceará with 52.5%  and in a municipality of São Paulo (SP), 52.4% .
With regard to data on the origin of the lawsuit, SUS demonstrated the highest percentage, similar to that identified in São Paulo (48%) , in the Federal District (85%) , as well as in Ceará  (76.3%), highlighting that in the Federal District and Ceará studies there was no distinction between public and philanthropic, although there were divergent findings in Minais Gerais (70.5%)  for the private sector.
The study by Machado et al.  identified that 66.3% of the lawsuits had requested at least one medication, while in the present study the percentage was 98.5%, corroborating that there is no pharmacotherapeutic “pool” being over judicialized. With regard to the low demand identified for antineoplastic drugs, this was not a particular characteristic of this study, since according to the classification of the main anatomical group of the ATC code, antineoplastic agents and immunomodulators make part of the main groups legally requested. However, they are generally not the most prevalent, as mentioned by Chieffi and Barata , who identified only 33% for antineoplastic drugs, which are nonetheless generally the most expensive treatments.
Considering that the median public expenditure per capita on healthcare in Brazil is around R$1,400 per year  (approximately US$271.53), it is evident that these lawsuits with antineoplastic drugs (US$7,508.8) may significantly impact the public health budget.
Since the values were detailed, it is possible to identify the unit price of medication, bearing in mind that price and therapeutic choice is one of the main inducers of spending on medication. Inference along these lines is widely discussed by Vieira  (2019), who clearly defined what induces public expenditure with medication; the three main inductions being: price, quantity and therapeutic choices, whereby variations in quantity and therapeutic choices are particularly significant for increasing expenditure on medications,.
On examining the most requested drugs, it should be noted that Cinacalcet and Somatropin 12UI are not primarily prescribed for neoplasms, even though there has been a history of Cinacalcet being prescribed for the treatment of parathyroid carcinoma and primary hyperparathyroidism and are included among the top 15, depending on the number of times it was requested. In the case of Abiraterone, Sorafenib and Bevacizumab, drugs suggested for oncology treatment, these are similar to those identified in other studies such as Vidal et al.  (2017), in INCA-RJ and Barreto et al.  (2019) in SES-PE.
Abiraterone, after several studies and requests in 2019, was incorporated into SUS by the Ministry of Health in the Ordinance Secretariat of Science, Technology, Innovation and Strategic Health Inputs - SCTIE N0 38/2019 . In 2015, Cinacalcet, which is recommended for secondary hyperparathyroidism (HPTS) through to chronic kidney disease, was incorporated into SUS by Ordinance SCTIE/MS No. 48/201529, and is also recommended for parathyroid carcinoma and primary hyperparathyroidism, but has not been incorporated for this purpose. This is why the use of off-label medications is always the subject of discussion, not only in SUS but also by the National Health Agency (ANS), which regulates the supplementary system .
An analysis of the profile regarding the territorial arrangement enables a direct correlation to be made between the municipality and the socioeconomic and health management region of the state, since Recife (29.4%), Jaboatão dos Guararapes (7.4%), Olinda (5.3%) and Paulista (4.3%) are located in the Metropolitan Region of Recife, as with Regional Health I, when grouped together, correspond to approximately 57.1% of the lawsuits. Studies, such as that by Nunes and Ramos Júnior , reported similar findings to those of this study, and identified more than 77% of the lawsuits referred to the municipality of residence, which in their case was Fortaleza, the capital of Ceará.
The data described from the municipalities of residence of the plaintiffs validate the characteristic of the state's profile, but it is not possible to attest that the socioeconomic profile of the plaintiffs interfered with the profile of judicialization in Pernambuco, nor was it the object of this study.
Figueiredo et al. , in a national study, with data retrieved from 2014, presented the total expenditure per capita on health in Brazil, which reached US$ 947, and that, when considering just one disease, such as cancer, reached US$ 12, suggests attention and relevance in detailed studies on the impact of diseases that place most pressure on health expenditure. In the same work published by Figueiredo, it was sadly reported that Brazil presented the lowest per capita daily public expenditure for covering public health actions and services of its population, (R$ 2.60 - U$ 0 .50), which is below expectations compared to other countries that have universal health systems.
Lastly, with the 2,947 medication lawsuits reported in this study, it has been possible to describe and discuss the profile of judicialization in healthcare in a state in the Northeast of Brazil, including relevant financial aspects for future lessons regarding financial impacts on public health management.