Drug pricing and reimbursement in France. Towards a new model?

The pharmaceutical market in France is characterised by low prices and high sales volumes. Despite these advantageous market conditions, the French pharmaceutical industry has in general been an underperformer in the global context. Acknowledgement of the contributory role made by state regulation of drug expenditures in creating this situation has resulted in a number of attempts to correct problems within the market. At best, these have achieved only temporary improvements. Since 1993, however, a new drug policy, which emphasises voluntary moderation by physicians of their own prescribing activities rather than the use of budgetary means to cut expenditures, has been in operation in France. This 'medicalised strategy' involves 2 main instruments, viz., a list of guidelines for clinical practice (Références Médicales Opposables) and a set of 'industrial conventions' (agreed between each drug company and the government) for determining drug prices. While it is too early at this stage to determine whether these new approaches will be beneficial in the long term, some changes in drug prescribing have already been observed, and it is clear that the new policy has also encouraged more healthy relationships between policymakers, the medical profession, and the pharmaceutical industry in France.