The term “insufficient medical service” is denounced by the Confederation of French Medical Unions (CSMF) which considers it inappropriate. What is your opinion on this recent controversy?

It was on the proposal of the Transparency Commission of the High Authority of Health that the deductions of August 2003 and March 2006 were decided. To find out more about the purpose of these measures, the criteria in force and the We have asked Prof. Gilles Bouvenot, Chairman of this committee.

The 152 medicines have therefore not been today deregorised because they are ineffective ...

Gilles Bouvenot: There is no real controversy, we are all of the same opinion. Since the establishment of the High Authority of Health (HAS), we have stressed that insufficient SMR does not mean ineffective drugs. But this terminology is inherited from the 1999 decree which excludes from reimbursement drugs whose "actual service rendered is insufficient to be taken in charge by the national solidarity". A new decree would enable us to avoid such confusion.

Are these medicines of comfort? Or drugs too expensive for small health risks?

Gilles Bouvenot: No, of course. All these products had to prove their effectiveness in obtaining a marketing authorization (MA). Among them, however, there are very old medicines whose performances are modest. But all relate to optional prescriptions, medicines prescribed in addition to the reference treatment, as a supplement.

The CSMF encourages physicians to continue to prescribe these drugs when they are no longer reimbursed. What do you think of this call that will be to the detriment of patients who will be out of their own pocket?

Gilles Bouvenot: No, the High Authority does not have an accounting or financial mission. Independent of public health authorities or private interests, the HAS must ensure the best relevance of the basket of reimbursable care. The Transparency Commission therefore proposes to register for reimbursement of new highly effective treatments. But because the res is not inextensible, this commission also proposes that the reimbursement of medicines whose profits are too modest to be taken care of by the national solidarity. Finally, we do not consider medications providing relief to the patient as comfort medicines. It is therefore an inappropriate term for these drugs.

Even if the role of the Transparency Commission is not accountable, the Health Insurance believes that these deductions will save nearly 250 million euros in 2006 alone. How to explain this paradox?

Will this second wave of disbursements be followed by others?

Gilles Bouvenot: Doctors will continue to prescribe these drugs. The extra cost to the patient will remain limited and reserved for drugs with modest performance. But we believe that the priority of national solidarity should be given priority to highly effective innovative medicines. The users of the health care system understand that you can not reimburse everything. Just as they know that in our country, that the management of serious diseases is assured. Let us give a simple example, the treatment of rheumatoid arthritis cost 1500 € a year, ten years ago for results not always satisfactory. Today, biotherapies have revolutionized the comfort of patients, but this revolution has a price: € 15,000 per year. All the patients who need these medicines can now benefit from it thanks to national solidarity.

Finally, the decisions of the Transparency Commission do not emanate from professors Nimbus locked up in their ivory tower. Most members are also practitioners: rheumatologists, gynecologists, general practitioners, pharmacists ...

Gilles Bouvenot: Everyone sees noon at his door and it is normal that the Health Insurance favors an accounting approach when its expenditures devoted to the reimbursements of drugs are constantly increasing and represent 17.5 billion euros for 2004. The Commission of Transparency is limited to changing the basket of reimbursable care by integrating what is very good and by dismissing what is not priority or not performing. Before any proposal is made, we ensure that the quality of care will not suffer.

As to whether the savings created by de-subscriptions (of medicines whose treatment rate had already been reduced to 35%) will make it possible to compensate for the arrival of very innovative and very expensive medicines, such as biotherapies or new anticancer drugs, I'm not so sure ...

Gilles Bouvenot: The Transparency Committee is currently studying the actual service rendered of 141 medicines (which in fact represent only about 50 active ingredients). These are for 75% of the vasodilators and for 20% of the antidiarrheal ones. But unlike the first two waves of de-reversion, these products are medicines that necessarily require a medical prescription. We will therefore increase our vigilance so that our recommendations for no reimbursement do not affect the quality of care. Our recommendations should be forwarded to the Minister of Health in about four months.