OBJECTIVES:   Cancer therapy reimbursements in the Brazilian Public Healthcare System (SUS) are controlled by the Authorization for High Complexity Procedures (APAC) system. Each treatment-line has a specific code/reimbursement value that should cover a month of therapy. We aimed to compare real chemotherapy costs versus SUS reimbursed values to evaluate how patients using SUS are being treated. METHODS: NCCN (National Comprehensive Cancer Network) guidelines and chemotherapy regimens (CTR) for metastatic colorectal cancer (mCRC) were reviewed. Chemotherapy costs were calculated and compared to mCRC APAC value: 2,224.00BRL or ~$556.00USD/month for first (1L) or second-line (2L) therapy. Drug factory prices +18% tax, age 65, weight 70kg, and body surface 1,70m were considered.  For medication with available generics we made two calculations: median price (MP) or lowest price (LP) with 30% and 50% discounts. Exchange rate 1USD=4BRL.  RESULTS: Twenty-nine CTR were recommended for 1L/2L mCRC. Four treatments with regorafenib or aflibercept were excluded (unavailable in Brazil). For 1L APAC value covered three CTR (fluorouracil plus leucovorin weekly, every 8 weeks and capecitabine) with 1L costs ranging from $46.81USD to $6,332.43USD (MP-30% discount) and $33.44USD to $5,503.76USD (MP-50%). No 2L regimen was covered by APAC value. Costs ranged from $1,697.31USD to $6,595.21USD (MP-30%) and $1,212.36USD to $5,867.80USD (MP-50%). Considering the LP approach, APAC value covered four 1L treatments: fluorouracil plus leucovorin weekly, every 8 weeks, capecitabine and FOLFOX. 1L costs ranged from $43.92USD to $5,544.82USD (LP-30%) and $31.37USD to $5,454.21USD (LP-50%). For 2L only FOLFOX was covered. Costs range: $542.77USD to $5,424.13USD (L-30%) and $386.69USD to $5,031.31USD (LP-50%). CONCLUSIONS: The APAC system has not been updated according to new available technologies. This may prove a barrier to patients’ access to newer treatments or lead hospitals to a negative balance on their budgets. In this scenario, healthcare providers may search for judicial or administrative alternatives to provide patients with treatment.