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Ongoing pharmaceutical reforms in France

Implications for key stakeholder groups

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Abstract

The rapid rise in pharmaceutical costs in France has been driven by new technologies and the growing prevalence of chronic diseases as well as considerable prescribing freedom and choice of physician among patients. This has led to the introduction of a number of reforms and initiatives in an attempt to moderate expenditure whilst ensuring universal coverage and rewarding innovation. These reforms include accelerating access to and granting average European prices for new innovative drugs, delisting drugs where there are concerns over their value and instigating rebates for excessive prescribing. Alongside this, ongoing initiatives to improve the quality and efficiency of prescribing include programmes to enhance generic prescribing and dispensing as well as to reduce antibacterial and anxiolytic/hypnotic prescribing.

However, there have been few publications documenting the impact of specific reforms on the overall costs and quality of care, which have been exacerbated by compartmentalization of budgets. Estimates suggest savings of over €27 million/year by decreasing antibacterial prescribing, €450 million/year by not reimbursing ineffective drugs, €670 million/year from pharmaceutical company rebates and approximately €1 billion/year from increased prescribing and dispensing of generics (year 2003–7 values). Additional savings of at least €1.5 billion/year are seen as being possible from increased use of generics such as generic proton pump inhibitors, statins (HMG-CoA reductase inhibitors) and ACE inhibitors instead of current branded products such as angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]).

Delisting drugs when there are concerns about their value provides an example to other countries with currently limited demand-side measures. Other possible examples include price : volume agreements and multifaceted campaigns to enhance generic prescribing and dispensing and reduce antibacterial prescribing.

Possible future initiatives could include adopting more stringent criteria for categorizing new drugs as innovative as well as further reductions in the prices of generics. Other initiatives could include further enhancement of the quality and efficiency of prescribing, including formal auditing of physician prescribing, as well as increasing efforts to monitor the risk : benefit ratio of new drugs post-launch in real-world practice.

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Acknowledgements

No sources of funding were used to assist in the preparation of this article. The authors have no conflicts of interest that are directly relevant to the content of this article.

The authors would like to thank Jacqueline Grassin for her help with supplying data on future initiatives in hospitals. The authors also thank Sylvain Pichetti for his help with proof reading and correcting earlier drafts.

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Authors and Affiliations

  1. IRDES (Institut de recherche et de documentation en économie de la santé), 10 rue Vauvenargues, 75018, Paris, France

    Catherine Sermet

  2. Pharmacie Galénique Industrielle et Cosmétologie, Université de la Méditerranée, Marseille, France

    Veronique Andrieu & Jean-Pierre Reynier

  3. Institute for Pharmacological Research ‘Mario Negri’, Via Giuseppe La Masa 19, 20156, Milan, Italy

    Brian Godman

  4. University of Liverpool Management School, Liverpool, UK

    Brian Godman & Alan Haycox

  5. Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden

    Brian Godman

  6. Pharmacoepidemiology Unit, Centre Hospitalier Universitaire-Lyon, Lyon, France

    Eric Van Ganse

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  1. Catherine Sermet
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  2. Veronique Andrieu
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  3. Brian Godman
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  4. Eric Van Ganse
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  5. Alan Haycox
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  6. Jean-Pierre Reynier
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Correspondence to Catherine Sermet or Brian Godman.

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Sermet, C., Andrieu, V., Godman, B. et al. Ongoing pharmaceutical reforms in France. Appl Health Econ Health Policy 8, 7–24 (2010). https://doi.org/10.1007/BF03256162

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