8. Prescription Medicines in France
Prescriptions in France are called ordonnances, a term that covers both medicines and other forms of treatment.
8.1. Reimbursement Rates
There is no uniform level of reimbursement for prescription medicines.
The level of reimbursement that applies will depend on the 'service rendered' (Service Médical Rendu - SMR) by the medicine, a quality that is determined by a number of parameters - the effectiveness of the drug, the gravity of the illness, the availability of alternative treatments and the value to public health.
This assessment is not based on your own medical condition, but an assessment of the drug itself.
The rate of reimbursement for prescriptions varies between 15% and 100%, depending on the type of medicine.
Medicines not considered essential will get the lowest rate of reimbursement, and less than 5% of drugs are available for 100% reimbursement.
There are four levels of reimbursement, as follows:
The levels of reimbursement used to be indicated by a colour slip on the prescription, but it is now merely shown on the bill you will receive, which is printed on the back of the prescription.
You will be required to pay 50 cents towards the cost of all medicines ( called the franchise médicale), except those given during hospitalisation. This charge applies to each medicine that may be prescribed. The same rule applies towards the costs of all auxiliary medical treatments, e.g. physiotherapy.
Thus, if you purchase a medicine costing €20 and it is reimbursed at the rate of 65%, you will be reimbursed €12.50 (65% of €20 = €13 - 0.50 = €12.50).
The amount of the excess is capped at €50 per year, per person.
This rule applies unless you are otherwise entitled to 100% reimbursement, as described in other pages in this guide.
Accordingly, if you visit your doctor, and you are prescribed four medicines, you will not receive reimbursement for the €1 consultation excess discussed in the previous chapter, nor the €2 for the prescription (€0.5 x 4).
As with doctors fees, prescription drugs are covered by the system of voluntary/complementary insurance.
As a general rule, your voluntary health policy will cover that part of the cost not met by the State, provided the medicine is on the prescribed list. If you have a premium policy it may pay the whole cost.
Most chemists have computer systems connected to both the State system and the main voluntary insurance funds, so, once registered with your local chemist, you may only need to hand over your carte vitale and pay nothing for the prescription.
In other cases, you may need to pay that part of the cost not funded by the State system, and then seek reimbursement from your voluntary insurer using the receipt provided by the chemist.
Where the chemist does not operate a computerised system, you will need to pay up front and make a claim for refund to your local CPAM and your voluntary insurer. Reimbursement will be made directly into your bank account.
Only 'generic drugs' (as opposed to 'branded' drugs) are reimbursable by the social security system, unless there is no generic substitute for the branded drug.
'Generic' drugs are copies of 'branded' drugs upon which the patent has expired. They are normally at least 30% cheaper than the original version. As a cost saving measure it is a major priority of the government to secure the widespread adoption of generic drugs.
Patients can specifically ask for branded drugs to be prescribed to them, but they will need to pay at the counter, and they will only receive reimbursement at the price and rate of the equivalent generic drug. In short, the chemist will insist you pay for it on the spot, and you will then have to seek reimbursement from your CPAM.
Homeopathic medicines have been reimbursable at the rate of 15% since 1st Jan 2020 (the rate was previousy 30%), and from 2021 they will no longer be reimbursable.
The chemist may dispense a medicine from the same generic group instead of the prescribed drug, unless your doctor has indicated on the prescription "NS" for non-substitutable.
In the event of a shortage of a drug, the chemist may replace the prescribed drug with another similar drug. They will write the name of the medicine they have dispensed on the prescription and inform your doctor of the replacement.
The chemist will supply you with medicines to last for a maximum of one month, except where you are going abroad for more than one month.
Some medicines are offered in packets for three month's treatment, in which case the chemist can deliver the medicine to you for this period.
In emergency situations, as part of an existing treatment, if the validity of the renewable prescription has expired, the chemist can dispense a medicine to you, with certain exceptions.
8.2. Non-Prescription Medicines
Chemists are permitted to sell some medicines without a prescription - sans ordonnance.
There are now around 500 medicines authorised for sale in this way and it is a market worth over €2 billion a year.
With the price of prescription medicines strictly controlled, and with the more widespread obligation to use lower margin generic alternatives, chemists are inevitably using sales from over the counter (OTC) medicines to make up for lost revenues.
Chemists are free to set their own prices for most of these medicines, and numerous consumer surveys in recent years have found that prices between one chemist and another can vary enormously.
Unless specifically prescribed by your doctor, these medicines are not reimbursable by the social security system, and most complementary insurers do not support them, so you will need to pay out of your own pocket.
The level of transparency over the prices of OTC medicines is also often rather poor.
Some medicines will be shown openly on the shelves of the chemist 'en libres service', whilst certain others will only be available 'derrière le comptoir', requiring that you ask the chemist for them.
Not only are the prices for behind the counter medicines rarely visible, but numerous consumer surveys have shown that these medicines are often cheaper alternatives to those on the front shelves.
One of the main reasons is that some of these medicines are price controlled by the government, as they are also available on prescription.
The pharmaceutical industry also sometimes goes to great lengths to confuse patients by playing on subtle differences in brand names.
Thus, one of the biggest selling drugs, the painkiller Nurofen is sold over the counter for an average of €4 a container, when the same supplier provides the equivalent price controlled medicine under the branding Nureflex for around €2.50.
Similarly, the anti-inflammatory drug 'AdvilMed' can be purchased for a fixed price controlled by the State, but there are many similar brands - Advil, AdvilCaps, AdvilGell AdvilEff - for which the chemist can charge their own price.
The same goes for the painkiller 'Doliprane', which has more expensive brands called DolipraneLib, DolipraneOro at prices determined by the chemist. The heartburn medicine Gaviscon is available at a lower fixed price than Gavisconell, which is not price controlled.
Do not count on the chemist to offer you the cheapest brand, for whilst some may do so, this is not systematic, as they earn more selling a non-refundable medicine whose price is not controlled by the government.
If in doubt, simply ask the chemist if they have a cheaper alternative.
At the present time you will not be able to buy OTC medicines anywhere other than at a chemist, as they hold a monopoly over the distribution of medicines. This is not necessarily bad news, as it does ensure all areas of the country have a local service.
The supermarkets have been pressing for years to be granted permission to sell non-reimbursable medicines, and they have been assisted in this campaign by the French Competition Authority, who have recommended a relaxation of existing rules. The government has so far resisted any change, but as a way of circumventing regulations some supermarkets now actually have a chemist inside some of their stores.
Since January 2013 it has also been possible to purchase over the counter medicines on French websites, but only chemists are authorised to sell on-line. Although the prices may be cheaper, it is questionable whether the cost of postage still makes it worthwhile and it is a highly risky practice as the provenance and quality of the medicines cannot be guaranteed.
Only chemists are allowed to dispense non-prescription drugs, so will you not find any in your local supermarket or corner shop, as occurs in many countries.
8.3. Medical Aids
The Government prescribes the medical aids and other medical treatments that are reimbursable, and the circumstances in which they are reimbursable.
Although the list is fairly comprehensive, there are circumstances where a patient might not be able to obtain reimbursement.
In all cases the advice and assistance of your doctor or specialist is necessary.
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