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Drugs reimbursed at 15%: inconsistencies in French policy

It is unacceptable to continue paying for drugs – even at  the reduced rate of 15% –  when their medical benefit rating is insufficient or their risk-benefit balance is negative.

Mid-April 2010, several hundred drugs on the French market were downgraded  by the national health insurance system to  a reimbursement rate of 15%. This reduced rate applies in principle to drugs whose medical benefit is deemed “weak” by the committee that assesses the medical benefits of new drugs and provides recommendations concerning drug reimbursement (Commission de la transparence).

The list of “drugs reimbursed at 15%” presents a number of inconsistencies and was made official without any explanation.

Drugs with an unfavourable risk-benefit balance should instead have been withdrawn from the market. These include painkillers piroxicam and floctafenine; ketoprofen and phenylbutazone as topical applications for osteoarthritis; quinine for cramps; muscle relaxant thiocolchicoside; some antiparkinsonian treatments (pergolide, tolcapone); flunarizine for migraine; psychiatric drug meprobamate; vasoconstrictor decongestant drugs (ephedrine, pseudoephedrine, naphazoline, oxymetazoline, tuaminoheptane).

Conversely, some drugs with a favourable risk-benefit balance are misguidedly included in this list and should in fact be reimbursed at a higher rate: antacids for heartburn, nasal cromoglicate for allergic rhinitis.

And lastly, drugs whose medical benefit is deemed not “weak” but “insufficient” are still reimbursable at 15%, instead of being non-reimbursable or withdrawn from the market: methocarbamol, tetrazepam, thenoic acid, a large number of vasodilators.

The French government would do better to stop reimbursing drugs that offer no proven benefit and to withdraw drugs with an unfavourable risk-benefit balance from the market.

©Prescrire August 2010

Source : "Médicaments à 15 % : des incohérences dans la liste publiée, sans argumentation" Rev Prescrire 2010; 30 (321): 498-501.