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France should give doctors bonuses to prescribe generics

Staff writer |
France is spending too much money on medicine and needs to promote the use of generic drugs.

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The French Court of Auditors recommends offering doctors incentives to prescribe cheaper generics to achieve this and capping their prescription budgets.

In its annual report, the French Court of Auditors found that France lags behind its European neighbours in the prescribing generic drugs and backs their use to help reduce the social security deficit.

Generic drugs represent only 21.5% of all social security reimbursements for drugs bought at French pharmacies, and less than one in three packets of reimbursable medicine is generic. In other European countries, like Germany and the United Kingdom, the proportion is more than three in four.

ccording to the last OECD Health at a Glance report, in 2011, generics accounted for three quarters of the pharmaceuticals market by volume in Germany, the United Kingdom, New Zealand and Denmark. In France the figure was one quarter.

As well as increasing the number of commercially available generic drugs, auditors said the incentive strategy needs revising. Large savings could be made on reward payments for pharmacists, who are currently the only ones promoting generic drugs to patients. This arrangement is inefficient and "extremely costly".

Under the current system, whenever a pharmacist replaces a patented drug with a generic version, saving at least €2, they pocket €1. According to figures from the Court of Auditors, pharmacists took €1.7 billion in bonus payments in 2013, but the net health insurance saving was only €1.6 billion. As a first step towards change, auditors urged a review of pharmacists' remuneration.

The Court of Auditors believes that doctors also have a role to play in promoting generic drugs, because "they tend to prescribe the latest products that are more expensive, still under patent, and often do not improve on the service offered by substitutable medicines".

The development of generics in France is also singled out for reform. More than half of drugs prescribed in France do not have a generic equivalent. In 2011, only 39% of statins used to treat cholesterol in France were generic, as opposed to 96% in Germany, 73% in Finland and the UK, and 72% in Norway.


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