[Role of drugs in therapeutic strategies]

When a medication receives an authorization for the release onto the market, it is necessary to determine the place that it will occupy in the therapeutic strategies with 2 regulatory steps: The Commission de la transparence (Commission for Transparency) gives an opinion on the target population, the placing in the therapeutic strategies, the level of medical benefit for patient, the restriction or not to hospital usage, and the inclusion in the national medical insurance reimbursement scheme for the medications that are not reserved to hospitals. The second step is the passage before the Comité économique du médicament (Medical Economics Committee) that fixes the price of re-emboursement of the product. The place that the medication will occupy depends on the expectations of the doctors, and through them the patients, and the promotional efforts of the pharmaceutic industry. The publicity is framed by a control a posteriori that relies on the advertising elements diffused in the press as much as on the documents presented or put to the doctors. The final place of a given medication in the therapeutic strategies depends on numerous factors that can lead to 2 specialised medicines having the same indications occupying very different parts of the market, without the prescribers being capable to easily justify the reasons that makes them choose one molecule over another.