The 15% reimbursement rate for drugs could be abolished, according to a scenario envisaged by a working group commissioned by the Ministry of Health.
The 15% drug reimbursement rate may soon be a thing of the past. The president of the working group on the evaluation of health products presented her first avenues for reform, revealed by the newspaper The echoes. She advocates in particular to put an end to this rate and wants an overhaul of the drug reimbursement system.
Medical Service Rendered
Currently, reimbursements are made according to three rates, established according to the actual benefit (SMR) of the drug concerned. Thus, a very useful and effective drug will be covered at 60% by the Health Insurance, and at 30% if it is moderately. A drug with a low AB will have a reimbursement rate of 15%, or zero. It is the HAS (Haute Autorité de Santé) which determines the SMR of a treatment.
However, according to Dominique Polton, adviser to the director of the National Health Insurance Fund, this system is currently too complex. Three scenarios therefore recommend its revision. One of them proposes to set up a “single reimbursement rate”, the level of which has not been specified. Another avenue would consist in creating a “temporary derogatory reimbursement”, for example for drugs with a low SMR but without therapeutic alternatives.
Clarify the criteria
In any case, Dominique Polton wants the establishment of a flat-rate payment system for non-reimbursed drugs “for very limited categories of patients” and in a very supervised manner “to prevent abuses”, still report The echoes. She also insisted on the need to “clarify and simplify the criteria” for admission to reimbursement of drugs, a task incumbent on the HAS.
The selected proposals should be presented to the working group on September 8. This group was set up by Marisol Touraine last March. It includes, among others, emissaries from the Ministry of Health.
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