France

Recommendations

Info

136 Health systems in transition France In terms of distribution, 64% of the industry’s turnover for drugs is distributed by wholesalers; 16.9% is sold directly to retail pharmacies and 19.1% to public and private hospitals by industry subsidiaries or contractors. Wholesalers form a very concentrated sector, with only seven firms supplying a distribution network of nearly 200 sites across the territory. Wholesalers have a public service mission and are highly regulated in terms of the range of drugs supplied, level of stock, delivery time within defined territories as well as their profit margins. They supply the 22 000 pharmacies with drug orders within a few hours, with deliveries three times per day on average. The French pharmaceutical market has three distinct components: medicines subject to mandatory prescription (prescription médicale obligatoire) and prescription-optional drugs (prescription médicale facultative), both of which are dispensed primarily through retail pharmacies, and drugs reserved for hospitals (see section 5.6.3). Before 2008, patients had no direct access to non-prescription medicines. Under a 2008 decree, patients may have direct access to a specified list of non-prescription drugs at the discretion of the pharmacist. Many pharmacists were opposed to this measure because they feared it was a step towards ending their monopoly, thereby allowing non-prescription drug sales by other retailers, such as supermarkets, which are currently prohibited. Internet sales of non-prescription drugs have been authorized in France since 2013, but uptake has been very limited. Only pharmacists are eligible to engage in this activity, which must be directly linked to a physical pharmacy and authorized by the ARS. By mid-2014, only 129 pharmacies had established web sites, a quarter of which were not operational. 5.6.2 Accessibility, adequacy and quality Most prescription drugs are covered by SHI, although to differing degrees depending on the assessed SMR. SHI reimbursement rates for most covered drugs ranges from 15% to 100% (see section 2.8.4). Over 97% of the French population is covered by a VHI contract, which generally covers the most important drugs up to 100%. Under the ALD programme, patients with certain diseases are covered 100% for treatments related to the disease, including drugs. Minors aged 15 and older are eligible for 100% coverage for certain contraceptives. Among the prescription drugs that are not covered by SHI are certain contraceptives, drugs for erectile dysfunction and some vaccines and eye drops.
Health systems in transition France 137 5.6.3 Levels of consumption Pharmaceutical expenditure per capita reached €525 in 2012 (DREES, 2013a), with each person consuming on average 48 packages of drugs (ANSM, 2013). For the first time ever, pharmaceutical expenditure decreased in 2012 (by 0.9%), which was the result of both a decrease in drug price and a slowdown in the increase in the volume of drug uptake. However, drug consumption per capita remains 22% above neighbouring countries (Sénat, 2013). General prescriptions must include certain standard information (patient’s name, name of the drug, dosage, treatment duration, number of renewals, etc.), as well as the notation NR if the drug is prescribed for an indication that is not reimbursable. Most prescriptions are for a month’s supply (three months for certain drugs packaged for longer-term therapy) and renewable for a maximum of 12 months. For patients with long-term conditions that qualify for coverage under the ALD programme, a bi-zone prescription form must be used to distinguish drugs that are reimbursed 100% under ALD from those that are subject to the usual reimbursement rules. Prescription of certain drugs is subject to restrictions or conditions, depending on their classification: • drugs classified as limited to hospitals (réserve hospitalière) may only be prescribed or administered in the course of a hospitalization; • drugs requiring a hospital prescription (prescription hospitalière) may not be prescribed in the ambulatory sector although they may be filled in retail pharmacies; • drugs requiring an initial hospital prescription (prescription initiale hospitalière) may be prescribed in the ambulatory sector only as a renewal after an initial hospital prescription within the period of validity specified in that prescription; • drugs for which the initial prescription is limited to certain specialists (prescription réservée à des médecins spécialistes) may be renewed by any doctor within the period of validity specified in the original prescription; • drugs requiring particular monitoring during treatment (surveillance particulière) may only be prescribed if a certain number of biological tests specified in the marketing authorization are undertaken;
Page 1 and 2:
Health Systems in Transition Vol. 1
Page 3 and 4:
Health Systems in Transition Karine
Page 5 and 6:
Contents Contents Preface
Page 7 and 8:
Preface Preface The Health Systems
Page 9 and 10:
Acknowledgements Acknowledgements T
Page 11:
Health systems in transition Franc
Page 14 and 15:
xii Health systems in transition F
Page 17 and 18:
List of tables, figures and boxes L
Page 19:
Abstract Abstract This analysis of
Page 22 and 23:
xx Health systems in transition Fr
Page 24 and 25:
xxii Health systems in transition
Page 26 and 27:
xxiv Health systems in transition
Page 28 and 29:
xxvi Health systems in transition
Page 31 and 32:
1. Introduction 1. Introduction The
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47:
Page 50 and 51:
20 Health systems in transition Fr
Page 52 and 53:
Page 54 and 55:
Page 56 and 57:
Page 58 and 59:
Page 60 and 61:
Page 62 and 63:
Page 64 and 65:
Page 66 and 67:
Page 68 and 69:
Page 70 and 71:
Page 72 and 73:
Page 74 and 75:
Page 76 and 77:
Page 78 and 79:
Page 80 and 81:
Page 82 and 83:
Page 84 and 85:
Page 86 and 87:
Page 89 and 90:
3. Financing 3. Financing Health ca
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116: Health systems in transition Franc
Page 129 and 130: 4. Physical and human resources 4.
Page 149: Health systems in transition Franc
Page 152 and 153: 122 Health systems in transition F
Page 185 and 186: 6. Principal health care reforms 6.
Page 205 and 206: 7. Assessment of the health system
Page 217 and 218:
Page 219 and 220:
Page 221 and 222:
Page 223 and 224:
Page 225 and 226:
8. Conclusions 8. Conclusions In Fr
Page 227:
Page 230 and 231:
200 Health systems in transition F
Page 232 and 233:
Page 234 and 235:
Page 236 and 237:
Page 238 and 239:
Page 240 and 241:
Page 242 and 243:
Page 244 and 245:
Page 246 and 247:
Page 248 and 249:
Page 250 and 251:
HiT country profiles published to d
show all

France

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?