Drug Reimbursement in France Keeps Rising. So Why Do Patients Feel Shortchanged?

Drug reimbursement in France is not shrinking. In the latest episode of the EN3S podcast Parlons peu, parlons Sécu, Maurice-Pierre Planel, a member of the Sciences Po Health Chair and former Deputy Director General of Health, walks through the numbers and lands on a counterintuitive conclusion: state health insurance now covers roughly 90% of medicine costs, more than it did a decade ago, even as many patients feel they are being reimbursed less.

Spending keeps climbing

Medicines accounted for about 26% of city care spending in France in 2024, the most recent year with consolidated figures. Gross reimbursements reached €37.9 billion, up 7.6% on 2023 and nearly 45% over five years. Planel puts that in perspective: the drug bill is larger than the budget of the Ministry of Ecological Transition and roughly half the national defence budget.

That headline figure is not what the health system really pays. Two mechanisms pull it down. Rebates negotiated with manufacturers lower the price, and a safeguard clause kicks in when spending overshoots the annual cap set in the social security financing law. Once both are applied, net reimbursements come to €27.2 billion, a difference of close to €10 billion. Net spending still rose 7.2% in 2024, after annual growth of about 2.6% between 2019 and 2023, an acceleration Planel attributes mainly to the rising volume of innovative, expensive medicines.

Drug reimbursement in France is rising, not falling

The consumption figures are notable. Nearly 62 million insured people were reimbursed for at least one box of medicine in 2024, which is effectively the whole insured population. That adds up to more than 2.5 billion boxes, unchanged from the previous year but rising steadily over five years. On average each person got 41 boxes a year, the same as in 2023 but down from 48 in the early 2010s. The figure climbs sharply with age: people over 80 are reimbursed for about 108 boxes a year on average.

The reimbursement rate itself keeps rising. In pharmacies it has gained almost seven points in ten years, from an already high 80.7% in 2014 to 87.6% in June 2025. Once medicines prescribed in hospital and dispensed in a city pharmacy are included, coverage passes 90%. That leaves patients with a remaining charge of about 10% of the cost.

By international standards that is generous. Germany, like France, maintains a high public coverage rate, while households carry a larger share in Belgium (about 27%), Spain (30%), the United Kingdom (35%) and Italy (37%).

Why patients still feel shortchanged

So why do French patients think they are being reimbursed less? Part of the answer lies in how the system sets its rates. There are several reimbursement rates: 15%, 30%, 65% and 100%. The rate depends on the clinical benefit, the service médical rendu, that the Haute Autorité de Santé assigns to each medicine after a technical assessment. A medicine with limited benefit for a minor condition gets a low rate, while a more effective one, or one used for a more serious condition, is covered at 65%. Essential and costly medicines are reimbursed in full. Medicines whose clinical benefit is judged insufficient are not reimbursed at all. A 15% rate for medicines with weak benefit was added in 2006.

Differentiating rates by medicine is rare abroad. Within the OECD only Belgium, Portugal and Hungary appear to do the same. Sweden works differently: patients pay the first roughly €180 out of pocket, reimbursement then rises in steps, and once total spending hits €350 in a rolling 12-month period the patient is covered in full.

For French patients, two things create the impression of worse coverage. The first is de-reimbursement and non-reimbursed medicines. De-reimbursements have been rare in recent years, homeopathy being one case Planel cites. But medicines that were never covered, like throat lozenges and cough syrups, add up to €2.7 billion a year, about 10% of net spending. The second is the flat fee, or franchise, introduced at €0.50 a box in 2008 and doubled to €1 in 2025, both capped at €50 a year. It is deducted from reimbursement. A €10 box reimbursed at 65% would normally return €6.50, but with the €1 franchise the patient gets €5.50. Because third-party payment means no money changes hands at the pharmacy, the deduction can turn up unexpectedly on a later consultation, and few people ever check what their medicines really cost.

Innovation concentrates the spend

The overall cost per patient is being driven up by innovation, and the spending is heavily concentrated. Medicines priced above €50 make up only 3% of volumes but 68% of reimbursed spending, a share that has climbed by more than 25% in ten years. At the other end, medicines under €5 account for 75% of volumes but just 10% of spending: the painkillers, statins and antibiotics used by millions. Medicines above €1,000, less than 0.5% of volumes, generate a third of total spending on their own.

The price inflation at the top is dramatic. In 2015 a single medicine exceeded an average annual treatment cost of €80,000 per patient. By 2025 there were 26. The ten most expensive medicines now cost more than €195,000 per patient per year, and two of them exceed €400,000.

Reimbursements follow the same pattern. Products judged innovative, meaning they bring a moderate-to-major improvement in clinical benefit, saw their reimbursements rise from €8 billion in 2017 to €10.7 billion in 2024, a 34% increase. Medicines bringing only minor or no improvement rose too, from €8.8 billion to €11.5 billion. Innovative treatments cost an average of €1,207 per patient in 2024, or €3,801 once vaccines are excluded. The least innovative medicines averaged €725 and €161 per patient respectively.

The conclusion Planel draws is that coverage remains very high, about 90% of the cost of medicines, but that this 90% is applied to medicines that keep getting more expensive. Patients are not being reimbursed less. The drugs they take are simply costing the system, and increasingly them, more.

Source: Parlons peu, parlons Sécu, EN3S, episode 44