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Specialist Treatments Contribute 56% to France's 2007 Medicine-Bill Increase
14 Mar 08
In 2007, oncological, antiretroviral and chronic-disease treatments accounted for the lion's share of French public health insurer CNAM's rise in medicine expenditure.
Global Insight Perspective | | Significance | Newer and more expensive medicines were responsible for the 2007 spike in public spending on reimbursable drugs, although expenditure was contained in other therapeutic areas. | Implications | The culprits contributing to the CNAM's 6.2-billion-euro (US$9.55-billion) have been named and are very much in line with expectations. | Outlook | With the introduction on the reimbursement list of new and expensive treatments, reining in expenditure in specialist therapeutic areas will be a next-to-impossible challenge. However, further cuts in generic prices and the "franchise" system might bring a reprieve to spending in other segments. |
In 2007, French public health insurer CNAM saw the bill for reimbursable medicines expand by 4.8% year-on-year (y/y) to reach 15.2 billion euro (US$23.4 billion). Fuelling the rise in the public drug bill were the so-called "specialist" treatments, namely anti-cancer and HIV drugs, reports French newspaper Les Echos. These types of drugs saw their prescription volume grow by 11% in 2007 and accounted for 56% of the reimbursement growth rate. The public insurer's expenditure was also fuelled by vaccines on the back of the introduction on the reimbursement list of cervical cancer vaccine Gardasil (Merck & Co; U.S.) commercialised in Europe by Sanofi-Pasteur (France; see France: 12 July 2007: Sanofi Pasteur MSD Secures 65% Reimbursement for Gardasil in France). On the other hand, there were a number of areas where expenditure was contained. For example, spending on statins decreased in 2007 thanks to generic competition as well as lower prices and volume prescription. Refunds on antidepressants, antipsychotics and anti-acids also went down in 2007. Selected Medicines Fuelling CNAM's 2007 Expenditure on Drugs | Drug | Therapeutic class | Reimbursement, Y/Y Growth (%) | Growth drivers | Anti-cancer drugs | Oncology | 25 | Antiretroviral drugs | HIV | 21 | Vaccines | Immunology | 17.5 | Insulin | Diabetes | 13.3 | Erythropoietins | Oncology | 11.3 | Contained expenses | Antibiotics | Infectious diseases | 1.5 | Statins | Cardiovascular | -3.7 | Anti-acids | Gastrointestinal | -2.2 | Antidepressants/antipsychotics | Mental Health | -2 | Source: Les Echos.
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In addition, Frédéric van Roekeghem, head of CNAM has announced that upon the introduction of the "franchise" co-payment system on 1 January 2008 (see France: 27 December 2007: New Patient Co-Payments on Drugs, Medical Treatment Made Law in France), medicine reimbursement decreased by 4.3% y/y in January, reports the source. The trend is likely to be the same in February. Roekeghem suggested that there might be a "franchise effect". Outlook and Implications With public expenditure under scrutiny in the country and the government expected to deliver on electoral promises, CNAM faces a tough year ahead (see France: 27 September 2007: Budget 2008: Tighter Controls on Healthcare Spending as French Conservatives Crack Down on Social Security Deficit). Although the introduction of the franchise system seems to have borne fruit so far (see France: 20 February 2008: New Co-Payment System Brings US$101.4 mil. in Savings for CNAM in January) and further savings could be on the way thanks to the introduction of additional price cuts on generics (see France: 20 January 2008: Generic Drug Prices in France Set for 6% Reduction in 2008), the rise in the medicines bill is not expected to significantly cool down in 2008. Realistically, with an ageing population, the growing incidence of chronic diseases and the availability of newer and costly treatments, the drug bill is likely to carry on creeping up. France is unlikely to deny its citizens access to newer and improved treatments as the country has traditionally prided itself on the quality of its public healthcare. Therefore, further cost-containment measures are likely to ensue in the form of price cuts, but there are also other areas, such as operating costs, that could be tackled to curtail public spending.
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