HistoriquePolitiqueMedicament

www.irdes.fr Juin 2013
La politique du médicament en France
avec un commerce total de 123,3 milliards d’euros. Les exportations ont constitué 65% de
ces échanges commerciaux. Les Etats-Unis étaient le deuxième acteur mondial pour le
commerce de ces produits, avec 74,9 milliards d’euros. Pendant la période 2000-2009, les
Etats-Unis étaient le partenaire commercial principal pour les exportations de ces produits
réalisées par l’UE-27. A la fois les exportati- ons et importations de l’UE-27 pour ces produits
ont plus que doublé pendant cette période et en 2009 les Etats-Unis ont représenté 35% du
commerce extérieur total de l’UE-27. La Suisse était le partenaire commercial principal pour
les importations, avec une croissance de 174% pour la période 2000-2009. En 2009, la
Suisse a représenté plus d’un cinquième du commerce extérieur total de l’UE-27 pour ces
produits
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Gree C.J., Maclure M., Fortin P.M., Ramsay C.R., Aaserud M. (2010). Pharmaceutical
policies: effects of restrictions on reimbursement : review. Cochrane Library (The), (8) : -90p.
Abstract: Public policymakers and benefit plan managers need to restrain rising
pharmaceutical drug costs while preserving access and optimizing health benefits. To
determine the effects of a pharmaceutical policy restricting the reimbursement of selected
medications on drug use, health care utilization, health outcomes and costs (expenditures).
We searched the 14 major bibliographic databases and websites (to January 2009). Included
were studies of pharmaceutical policies that restrict coverage and reimbursement of selected
drugs or drug classes, often using additional patient specific information related to health
status or need. We included randomised controlled trials, non-randomised controlled trials,
interrupted time series (ITS) analyses, repeated measures studies and controlled beforeafter
studies set in large care systems or jurisdictions. Two authors independently extracted
data and assessed study limitations. Quantitative re-analysis of time series data was
undertaken for studies with sufficient data. We included 29 ITS analyses (12 were controlled)
investigating policies targeting 11 drug classes for restriction. Participants were most often
senior citizens or low income adult populations, or both, in publically subsidized or
administered pharmaceutical benefit plans. Impact of policies varied by drug class and
whether restrictions were implemented or relaxed. When policies targeted gastric-acid
suppressant and non-steroidal anti-inflammatory drug classes, decreased drug use and
substantial savings on drugs occurred immediately and for up to two years afterwards, with
no increase in the use of other health services (6 studies). Targeting second generation
antipsychotic drugs increased treatment discontinuity and the use of other health services
without reducing overall drug expenditures (2 studies). Relaxing restrictions for
reimbursement of antihypertensives and statins increased appropriate use and decreased
overall drug expenditures. Two studies which measured health outcomes directly were
inconclusive. Implementing restrictions to coverage and reimbursement of selected
medications can decrease third-party drug spending without increasing the use of other
health services (6 studies). Relaxing reimbursement rules for drugs used for secondary
prevention can also remove barriers to access. Policy design, however, needs to be based
on research quantifying the harm and benefit profiles of target and alternative drugs to avoid
unwanted health system and health effects. Health impact evaluation should be conducted
where drugs are not interchangeable. Impacts on health equity, relating to the fair and just
distribution of health benefits in society (sustainable access to publically financed drug
benefits for seniors and low income populations, for example), also require explicit
measurement
Nolte E., Newbould J., Conklin A. (2010). International variation in the usage of medicines. A
review of the literature : Santa Monica : Rand corporation.
Abstract: The report reviews the published and grey literature on international variation in the
use of medicines in six areas (osteoporosis, atypical anti-psychotics, dementia, rheumatoid
arthritis, cardiovascular disease/lip- id-regulating drugs (statins), and hepatitis C). We identify
three broad groups of determinants of international variation in medicines use: (1) Macro- or
Pôle documentation de l’Irdes – Safon M.-O., Suhard V. avec la collaboration de Pichetti S.
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