France is spending too much money on medicine and needs to promote the use of generic drugs. The French Court of Auditors recommends offering doctors incentives to prescribe cheaper generics to achieve this and capping their prescription budgets.
In its annual report, the French Court of Auditors found that France lags behind its European neighbours in the prescribing generic drugs and backs their use to help reduce the social security deficit.
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Generic drugs represent only 21.5% of all social security reimbursements for drugs bought at French pharmacies, and less than one in three packets of reimbursable medicine is generic. In other European countries, like Germany and the United Kingdom, the proportion is more than three in four.
According to the last OECD Health at a Glance report, in 2011, generics accounted for three quarters of the pharmaceuticals market by volume in Germany, the United Kingdom, New Zealand and Denmark. In France the figure was one quarter.
Reviewing the strategy
As well as increasing the number of commercially available generic drugs, auditors said the incentive strategy needs revising. Large savings could be made on reward payments for pharmacists, who are currently the only ones promoting generic drugs to patients. This arrangement is inefficient and “extremely costly”.
Under the current system, whenever a pharmacist replaces a patented drug with a generic version, saving at least €2, they pocket €1. According to figures from the Court of Auditors, pharmacists took €1.7 billion in bonus payments in 2013, but the net health insurance saving was only €1.6 billion. As a first step towards change, auditors urged a review of pharmacists’ remuneration.
Following the German example
The Court of Auditors believes that doctors also have a role to play in promoting generic drugs, because “they tend to prescribe the latest products that are more expensive, still under patent, and often do not improve on the service offered by substitutable medicines”.
The development of generics in France is also singled out for reform. More than half of drugs prescribed in France do not have a generic equivalent. In 2011, only 39% of statins used to treat cholesterol in France were generic, as opposed to 96% in Germany, 73% in Finland and the UK, and 72% in Norway.
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The Court of Auditors wants to incentivise the prescription of generic treatments in France, giving doctors targets and reducing their pay if they fail to meet them.
This proposal is based on the German model. During the 1990s, budget limitations on prescriptions saw German doctors offered financial incentives to prescribe cheaper drugs. If the budget limit was exceeded, the doctors risked having to pay back part of their income.
The auditors said that between 2010 and 2013, the share of generics in reimbursable medicines rose from 50% to 75% by volume in Germany, while in France the increase was from 24% to 31%.
The high cost of long-term illness
In 2012 about 9.5 million French citizens suffered from long term illnesses, according to social security figures. This number rises by an average of 3.8% each year, and could reach 11 million by 2016.
These illnesses fall into 30 categories that demand prolonged and “particularly expensive treatments”, the cost of which is fully covered by French social security. In 2010, four groups accounted for three quarters of the spending increase on long term illnesses: cardiovascular disease (30%), malign tumours (15%), diabetes (16%) and long term psychiatric illnesses (14%).
Two thirds of French health insurance reimbursements are paid out for treatments for these illnesses, amounting to €80 billion of health spending each year.
The criteria for what constitutes a long-term illness have been revised with a view to reducing this bill, and in 2011 the French government removed severe high blood pressure from the list.