Guide to French Health System

8. Prescription Medicines and Pharmacies 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 prescription medicines varies between 15% and 100%, depending on the type of medicine, although from 1st Jan 2027 the rates for medicines of lower effectiveness are being reduced.

Medicines with a low medical service rating receive the lowest rate of reimbursement, while medicines recognised as irreplaceable and particularly costly can be reimbursed at 100%.

For 2026 there are four levels of reimbursement, as follows:

The reimbursement rates apply to the regulated reimbursement basis for the medicine, which may be the selling price or a fixed responsibility tariff.

You will be required to pay €1 towards the cost of reimbursed medicines (called the franchise médicale). The charge applies to each box of medicine, or other unit of packaging such as a bottle. It does not apply to medicines supplied during hospitalisation. The annual total is capped at €50 per person, although see below.

Thus, if you purchase a medicine costing €20 and it is reimbursed at the rate of 65%, you will be reimbursed €12.00 (65% of €20 = €13 - €1.00 = €12.00).

This rule applies unless you are otherwise entitled to 100% reimbursement, as described in other pages in this guide. Note, however, that the franchise médicale can still apply in some cases even where treatment is covered at 100%, such as for an major/long-term illness (ALD).

Accordingly, if you visit your doctor and you are prescribed four medicines, you will not receive reimbursement for the €2 consultation (participation forfaitaire) discussed in the previous chapter.

There is also a €2 participation forfaitaire on laboratory tests. The €2 participation applies to each medical consultation or act and to biological laboratory tests, subject to the applicable daily and annual limits.

There are further changes planned for 2025, which we covered in France Insider at Health Treatment Charges 2025. However, the government backed off these changes.

Nevertheless, in July 2026 the government published new decrees reducing the level of reimbursement for medicines of weak or moderate value. In addition, there were also increases in the ceiling for patient contributions. These changes are operative 1st Jan 2027 for the reduction in reimbursements and Oct 2026 for the increase in the ceiling for patient contributions. You can read more in Transfer of Health Costs to Complementary Insurers.

In addition, from 1 September 2026, the rules on third-party payment (tiers payant) change where a patient refuses a biosimilar or hybrid medicine when one is available, unless there is a medical justification. In such cases, the patient may have to pay the full price of the original medicine and reimbursement may be based on the price of the relevant biosimilar or hybrid medicine.

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. However, complementary insurers cannot reimburse the franchise médicale.

Most pharmacies have computer systems connected to both the State system and the main voluntary insurance funds, so, once registered with your local pharmacy, you may only need to hand over your carte Vitale and pay nothing for the prescription. If you are entitled to tiers payant, you will not normally need to advance the reimbursed part.

However, tiers payant may not apply if you refuse a generic medicine, and from 1 September 2026 the same principle extends to certain refusals of biosimilar and hybrid medicines.

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 pharmacy.

Where the pharmacy does not operate a computerised system, you will need to pay up front and make a claim for reimbursement to your local CPAM and your voluntary insurer. Reimbursement will be made directly into your bank account.

Generic drugs are normally used in place of branded medicines where an equivalent generic exists. The pharmacist may substitute a generic medicine unless the doctor has indicated that substitution is not appropriate.

Generic drugs are copies of branded drugs upon which the patent has expired. They are normally cheaper than the original version. As a cost-saving measure, the government encourages the widespread adoption of generic medicines.

Patients can specifically ask for branded drugs to be prescribed to them, but depending on the circumstances they may need to pay at the counter and seek reimbursement based on the applicable reimbursement price rather than the full price of the branded medicine.

The chemist may dispense a medicine from the same generic group instead of the prescribed drug, unless your doctor has indicated on the prescription that it is non-substitutable.

From 1 September 2026, similar rules also apply to certain biosimilar and hybrid medicines. If you refuse a biosimilar or hybrid medicine without medical justification, you may lose the benefit of tiers payant and, if the original medicine costs more, part of the difference may remain at your expense.

In the event of a shortage of a drug, the pharmacist may replace the prescribed drug with another medicine where the regulations permit. They will write the name of the medicine they have dispensed on the prescription and inform your doctor where required.

The pharmacy will normally supply you with medicines to last for a maximum of one month at a time, although some medicines are available in three-month packs. For a chronic treatment, an ordinary renewable prescription can generally cover treatment for up to one year, subject to exceptions.

The French government has introduced some relaxation of the rules on repeat prescriptions. In particular, where an expired renewable prescription concerns a chronic treatment prescribed for at least three months, a pharmacist may, subject to conditions, dispense the medicines for up to three months, in one-month instalments, in order to avoid interruption of treatment.

Further changes were introduced in December 2024, permitting pharmacies to offer a further three months of medicines to patients with a major illness (ALD) without the need for an additional prescription from their doctor.

The regulation allows this exceptional continuation of a chronic treatment where interruption would be prejudicial to the patient's health, subject to the conditions laid down in the regulations.

In emergency situations, as part of an existing treatment, if the validity of the renewable prescription has expired, the pharmacist can dispense a medicine to you, with certain exceptions.

If you are a visitor to France and you seek a prescription, then you can go to a doctor for a consultation, pay their fee and they will provide a prescription you can take to the pharmacist. This is possible even though you may not be in possession of an EHIC/GHIC, although unless you have either you will not normally be able to obtain reimbursement under the relevant European arrangements. Most private travel health insurance excludes routine treatment.

Alternatively, bring your home prescription with you and take it direct to the pharmacy. Many will be willing to provide you with the medication, although you may have to 'shop around'. Whether a foreign prescription can be dispensed depends on the medicine and the requirements applicable to the prescription.

8.2. Non-Prescription Medicines

Pharmacies 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, pharmacies are inevitably using sales from over-the-counter (OTC) medicines to make up for lost revenues.

Pharmacies 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 pharmacy 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 pharmacy en libre-service, whilst certain others will only be available derrière le comptoir, requiring that you ask the pharmacist for them.

Not only are the prices for behind-the-counter medicines rarely visible, but numerous consumer surveys have shown that these medicines can be 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 and AdvilEff - for which the chemist can charge their own price.

The same goes for the painkiller 'Doliprane', which has more expensive brands called DolipraneLib and 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-reimbursable 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 pharmacy, 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, which has 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 pharmacy inside some of their stores.

It is also possible to purchase over-the-counter medicines on French websites, but only pharmacies are authorised to sell medicines online. Buyers should use an authorised pharmacy website, since medicines purchased from unauthorised sources may be counterfeit or otherwise unsafe.

Only pharmacies are allowed to dispense non-prescription drugs, so you will not find them in your local supermarket or corner shop, as occurs in many countries.

The government has also authorised pharmacists, under specific conditions and following appropriate testing, to dispense certain antibiotics without a prescription. This applies, in particular, to some cases of bacterial cystitis and streptococcal sore throat.

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.

8.4. Vaccinations

Pharmacies are authorised to administer and, within the scope of their expanded powers, prescribe a wide range of vaccinations.

Since 2026, pharmacists can prescribe and administer the vaccines included in the current vaccination schedule to adults and children aged 11 and over, subject to certain exceptions, notably concerning live vaccines in immunocompromised people.

The vaccines that pharmacists can administer include, among others, diphtheria, tetanus, whooping cough, hepatitis A and B, influenza, Covid-19, HPV, measles, mumps, rubella, meningococcal and pneumococcal vaccines, subject to the applicable recommendations and conditions.

Pharmacists can vaccinate against influenza from the age of 11, while Covid-19 vaccination by pharmacists is available from the age of 5.

The cost of the vaccination itself varies according to the vaccine and circumstances. The pharmacist's vaccination fee is currently €7.50 for vaccines not requiring a prescription and €9.60 where a prescription is required and the patient does not have one.

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