How you are reimbursed for your medicines

Reimbursement for medicines varies from 15% to 100% depending on how vital and effective the medicine is thought to be. At the pharmacy the patient hands over their carte Vitale and a card for their mutuelle, if they have one. 

Any part of the cost attracting a state reimbursement is not payable upfront by the patient – the pharmacist is reimbursed directly by the state. 

The mutuelle card allows the pharmacist to check the patient’s top-up cover, and, if appropriate, there is no need for upfront payment of this part either. 

Reimbursement is only available for prescribed medicines. The part not reimbursed is payable by the patient or their mutuelle (if they have one and it has sufficient cover to top-up the full cost). Medicines have different levels of reimbursement based on how medically effective and essential they are deemed to be.

• 100%. For irreplaceable medicines for treating very serious illnesses that are costly to treat

• 65%. Very significant effect (there are proposals to reduce this to 60%)

• 30% (25% is proposed). Moderate effect. This includes some préparations magistrales (medicines specially made by the pharmacist).

• 15%. Weak medical effect.

The levels used to be reflected in coloured stickers on boxes called vignettes but the information is now shown in other ways, notably printed on the back of the original prescription by the pharmacist called the ticket vitale. 

Another way of checking is to scan a code on the box using the smartphone application medicaments.gouv.

Other signs on drug containers giving information on them include an upside-down black triangle which indicates the drug is on the European watch list for drugs that may have harmful side-effects. 

Three triangle signs are also used to show possible effects for drivers – with a red triangle warning motorists that they should not drive while taking the medicine. All medicines come with an information sheet explaining how they are taken, the usual dose, common side effects etc.

As important new medicines arrive on the market some older ones may have their reimbursement decreased or removed following a decision by the Health Ministry. If you will be taking a medicine longterm, it may be useful (where this is an option) to go for the largest format box, to minimise franchise payments (a small amount taken off reimbursement per box). 

A law was passed to encourage dispensing certain medicines by precise quantity prescribed rather than in packets of set amounts, to cut wastage. This is called la dispensation adaptée. Medicines concerned include some painkillers, medicines for bowel problems and antiseptics and disinfectants.

Another change in recent years was that pharmacists are able to levy small charges called honoraires de dispensation which are shown on the ticket vitale information that the pharmacist stamps on the back of your prescription. This is meant to better remunerate the pharmacist’s work in analysing the prescription, providing advice, or adapting the amount of medicine to your needs. 

These fees mount up per box of medicines and per prescription and vary depending on factors including the size of the box and how complex the prescription is. 

They are reimbursed by the state to the same amount as the medicines, and the rest is usually picked up by your mutuelle.

• Another official source of information on specific medicines is base-donneespublique.medicaments.gouv.fr. It gives the information included in the medicine’s advice leaflet plus other facts like different formats it comes in, the name of any generics, how much it costs, how much is state reimbursed etc.

• In the case of certain experimental medicines or medicines for rare diseases etc that are not yet normally available and/or reimbursed in France, it is possible in some cases for a ‘compassionate access’ protocol to be organised to make them available to a patient or cohort of patients before they have received normal marketing approval. This is sometimes granted where there is demand from a group of patients and their doctors.

“It’s always been possible in France for us to organise access for products thought to be innovative, with a potential gain for the patient’s hopes and strong demand from patients,” said a spokeswoman for the ANSM medicines authority.