Insurers rethink medicine refunds
Private health insurers are looking to cut refunds for medicines that are considered 'ineffective'
A PATIENTS’ rights group has criticised new plans by private health insurers to cut refunds for medicines that are considered “ineffective”.
Mutualité Française, which represents 700 top-up health insurers, says it needs to cut back reimbursements on products with little or no medical value to focus money on essential items.
However the Collectif Interassociatif sur la Santé (CIS) fears the change in refund policy will deny access to day-to-day medicines for low earners.
More than 90% of people in France have some form of top-up insurance (called mutuelles or complémentaires santé). They pay the healthcare costs not covered by the state.
Mutualité Française says that, until now, mutuelles have been “blind” to the products they are refunding. The only information they had was the price and the percentage covered by the state, which ranges from 15% to 100%.
France’s data protection watchdog has now given insurers access for the first time to a comprehensive database managed by the Haute Autorité de Santé, which includes reports on the effectiveness of every medicine sold in France, called the service médical rendu.
A three-year experiment has been launched to assess the case for linking this effectiveness score to the refund rate.
Mutualité Française health director Agnès Bocognano said: “Unless people want their policies to become more and more expensive, we need to reach the stage where we only reimburse items that are recognised as effective.
“If we discover that we have been spending a lot of money refunding a muscle relaxant that is not very effective, while spending little on a very effective painkiller, we could reimburse the first one at a lower rate and the second one at a higher rate.”
CIS spokesman Christian Saout said the changes risked creating a two-tier private health insurance system. He said “low-cost” policies would offer poor refund levels on all but the most essential drugs, while well-off patients would pay high premiums to have their day-to-day healthcare paid back in full.
Mr Saout added that the concept of “effectiveness” was misleading, as different medicines suit different people. Some pain relief pills, for example, have proved to work well on patients who spend a lot of their day standing up, while others saw no benefits from the drug at all.
Top-up health insurers have come under increasing financial pressure this year, as Assurance Maladie has cut its reimbursement rates on several hundred medicines.
The state has introduced a new rate of 15% for products it considers to have a limited medicinal purpose, including various brands of indigestion tablet and antiviral cream.
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