Medicines of comfort or really useful?

In the middle of the weekend Pascal, the decision of the Minister of Health could have gone unnoticed but it was not counting the attachment of the French to their health. The reduction in the reimbursement of 617 drugs from 65 to 35% arouses strong reactions. Are your treatments in this list? What can this measure mean? Discover all the issues.

List of 617 medicines concerned

As part of measures to reorganize the Health Insurance accounts, on 18 April 2003, Minister Jean-François Mattéi signed a decree providing for a reduction in the reimbursement rate from 65 to 35% of 617 medicines. The choice of medicines, the method and the consequences of this decision have raised many controversies.

Strong reactions

The medicines concerned were estimated to have a "Rendered Medical Service (SMR) judged to be low or moderate". As early as 1999, the drugs of our pharmacopoeia and the studies that concern them were dissected by the Transparency Commission, a working group under the authority of the Minister of Health. For each product, an opinion is made, based on its effectiveness, its safety of use, its place in the treatments, its indications, its conditions of use and its interest in terms of Public Health.
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Tomorrow 650 derecognized drugs

The decision to reduce the reimbursement of these 617 drugs is expected to save € 370 million. This list includes skin antifungals, antiseptics, antiacnetics, some medications to treat gastroesophageal reflux or nausea and some antihistamines ... But among the medicines concerned, there are real best-sellers like the anti-histamine Zyrtec ©, or the anti-inflammatory Voltarene ©, or the Zovirax © used against herpes. One might think that there is an equivalent generic for each of these products, it is not. This did not justify the decisions. Thus, some believe that the hard core of our pharmacopoeia is affected and that we are far from comfort products ...

The drug, a source of savings too!

The Mutualité Française, the union confederations FO, CGT and CGC, several medical unions (MG-the United States, SML), but also the National Health Insurance Fund ( Cnam), whose President interviewed on RTL assured on 23 April that he had "not been informed of this decision" and learned it "by the press". In La Croix he said: "I note that this decision is strictly financial and I do not see its medical basis."

Jean-Pierre Davant, President of the Mutualité Française, notes that "For mutuals, the cost of this decision will be in the order of 200 million € uros in a full year. Contrary to the Minister's Health, it is the households that will pay the cost of this measure, either through the amount of their contribution to a mutual or directly ... It must be realized that this decision will only increase the difficulties of Access to care, especially for households that can not, for financial reasons, afford complementary coverage but whose incomes are too high to benefit from universal health coverage. "

For Jean-Pierre Cassan, President of the Leem, a union representing pharmaceutical companies, questioned by we "We can not be satisfied when the rate of reimbursement of certain medicines falls, but this decision is not really a surprise, Following the various opinions concerning the SMR of these products dating from 1999 ".

At that date, the Transparency Committee had identified 835 medicinal products whose SMR was insufficient and which should not be reimbursed. Today, these drugs are not affected. Also, some would have felt more logical that the latter would be the first to suffer from budgetary decisions ... But according to the Minister, it will not be long.

In an interview with the daily La Provence, the Minister of Health said: "I will completely deregister the 650 medicines rendered inadequate or invalid in three waves, in July 2003, 2004 and 2005". What are these drugs?

According to the opinion of the Transparency Committee of 1999, several categories can be distinguished. Some contain small amounts of antibiotics, cortisone like some syrups. Others do not provide scientifically proven medical improvement. This is the case of veinotonics, vasodilators, digestive treatments to combat bloating, constipation, heartburn, mild sedative.

Magnesium, bronchial fluidizers and many cough and sore throat medications would also be affected.

Meanwhile, the President of Leem tells us: "The Medicinal product represents 16% of the reimbursements of the General Health Insurance Scheme, so the drug should not be considered the magic solution to the social security deficit. Is only part of the health system. "

On the other hand, considering medicines solely as a source of expenditure is, in his view, quite reductive. Thus, he would like to recall that "The drug can also be a source of savings.

Thanks to the various therapeutic advances, infarcts can be managed in 4 to 6 days of hospitalization, compared to one month a decade ago. In the treatment of certain cancers, several drugs allow home treatment, less expensive and more comfortable for the patient who remains in a family setting. Finally, the drug is often the cornerstone of therapeutic progress. "

In spite of the announcements of forthcoming demerger of products judged to SMR insufficient, the Minister is aware of this aspect. According to his speech to present the Social Security Financing Bill (PFLSS) 2003, he announced in the daily newspaper La Provence the reimbursement of new innovative medicines, such as Glivec® against chronic myeloid leukemia, Cost per box is 4,000 € uros ...

But beyond this accumulation of declarations, a real debate on the health of the French seems today to impose itself in broad daylight and with all the health actors. Recall that the deficit of the Health Insurance should soon be announced, the estimates range from 6 to 9 billion euros.