health
France to stop full refunds on low-benefit medicines for long-term illness patients
Around 171 medicines are set to including including Valium and Gaviscon
From October 1, patients with a long-term illness (ALD) status in France will no longer receive full reimbursement for some everyday medicines, even when prescribed as part of their ALD treatment.
Under normal rules, France's ALD system (affection de longue durée) exempts patients from the standard co-payment (ticket modérateur) on medicines linked to their condition, meaning they are reimbursed at 100% rather than the usual rate.
A decree published in the Journal Officiel now changes this for medicines classified as having a "low medical benefit" (service médical rendu faible, or SMR faible).
Which medicines are affected?
The change applies to around 171 medicines that already carry a reduced standard reimbursement rate of 15% for the general population. Previously, ALD status lifted that rate to 100%. From October, it will not: these medicines will be reimbursed at the ordinary 15% rate for everyone, ALD patients included.
The list includes common over-the-counter and prescription products such as Gaviscon (for acid reflux), Spasfon and Météospasmyl (for digestive spasms and bloating), Dexeryl (for dry skin), Tanakan (for cognitive and balance complaints), Bétadine antiseptic, Zovirax/aciclovir cream for cold sores, and Valium.
No single official document appears to list all 171 products in one place. Patients wanting to check whether a specific medicine is affected can search it directly on France's official medicines database.
Each medicine's entry shows its SMR rating and standard reimbursement rate: a rating of "faible" or “insuffisant” should help identify medicines included in this change. Pharmacists can also confirm a medicine's status directly via their dispensing software.
ALD recognition itself is unaffected
The reform does not touch medicines with a "significant" or "moderate" medical benefit rating. Core treatments for chronic conditions: insulin, blood pressure medication, thyroid treatment and cancer drugs among them remain fully reimbursed at 100% under ALD status, as do essential medical devices such as blood glucose monitors and insulin pumps.
In other words, patients will not see a change to their main treatment, only to the ancillary medicines often prescribed alongside it.
Pharmacists are being briefed ahead of the change, since it will show up directly on bills.
Patients without a complementary health insurance policy (mutuelle) that covers the shortfall will feel the change most. Unlike the franchise médicale (flat-rate charges that mutuelles are barred from covering), the new 85% co-payment on these medicines can be reimbursed by a mutuelle, depending on the contract.
What is behind the change
The move follows a recommendation in the health insurance fund Cnam's annual report on spending. Cnam director Thomas Fatôme told a parliamentary committee in February that a medicine rated as having limited effectiveness did not justify full reimbursement, warning that if nothing changed, ALD-related care could account for three-quarters of the health insurance budget by 2035.
Some 12 million people in France currently hold ALD status, and, according to health ministry data, their average annual out-of-pocket healthcare cost already runs to roughly €1,055, about double that of non-ALD patients.
Patient advocacy group France Assos Santé has criticised the measure, arguing that some low-SMR medicines are essential for managing serious or disabling conditions and their side effects, and that for patients juggling multiple treatments, "every euro counts."
The group warns the change risks pushing people to forgo treatment and deepening health inequalities.
A second change on the same day
The change comes alongside another cost-saving measure taking effect on the same date: the annual cap on franchise médicale (small flat-rate applied to medicines, paramedical acts and medical transport) rises from €100 to €140 per person.
Unlike the co-payment change above, this franchise médicale increase cannot be offset by a mutuelle, meaning it is a genuine additional cost for every patient..
Combined, the two changes mean many long-term illness patients will see noticeably higher out-of-pocket costs from October, even though their core treatment remains fully covered.
Read also how retirees, the self-employed and others who pay for their own health top-up insurance are set to be among those most exposed to higher healthcare costs in 2027.
