Question 13340 — pharmacy and medications

Summary

Ms Sandra Delannoy questions the Minister of Health, Families, Autonomy and People with Disabilities on the continued deterioration of the economic balance of community pharmacies, in a context marked both by regular reductions in the price of reimbursable medicines and by a structural evolution of the pharmacy remuneration model. Price cuts constitute a central instrument for regulating consumer spending. health insurance. Their legitimacy in a logic of sustainability of social finances is not contested. However, their immediate entry into force may weaken pharmacies when they hold stocks acquired at a price higher than the new regulated public price. The price of reimbursable medicines being strictly set by the State, the pharmacist cannot under any circumstances pass on the variation to the patient. He can thus being forced to sell at a loss units purchased at a cost higher than the public price now applicable. Beyond these cyclical effects, it is more broadly the very structure of pharmacy remuneration that raises questions. The smoothed decreasing margin, calculated as a percentage of the manufacturer's price excluding taxes (PFHT), decreases as the price of the medicine increases: 10% for the range from 0 to 1.91 euros, 7% from 1.92 to 22.90 euros, 5.5% from 22.91 to 150 euros, 5% from 150.01 to 1,930 euros. In a context where the share of expensive treatments is increasing, the turnover of pharmacies can increase mechanically without the net margin evolving in the same proportions, which compresses profitability. For example, the drug Kaftrio, indicated in the treatment against cystic fibrosis, has a public price of 8,564.10 euros. The corresponding margin for the pharmacy is approximately 131.15 euros, while VAT at the reduced rate of 2.1% represents approximately 179 euros. Thus, the amount of tax collected by the State exceeds the gross margin received by the pharmacist, even though the pharmacy bears the cash advance linked to the purchase of the product. This situation may lead certain pharmacies, in particular the most fragile, to hesitate to list or order these specialties, with a risk potential on continuity of access to treatments. Furthermore, pharmacies are reporting delays or incidents in health insurance payment, aggravating cash flow tensions, as well as a continued increase in operating costs, particularly salaries. At the same time, the remuneration linked to dispensing fees has not evolved in accordance with conventional commitments. A revaluation of 10 cents per order, provided for as part of the agreement signed with health insurance, increasing the fee to 0.61 euros instead of 0.51 euros, would not have been implemented on January 1 as initially announced. According to professionals, the cumulative effect of price reductions, the increase in expensive drugs with low margins and the increase in charges results, in certain pharmacies, in a significant reduction in income. available, estimated at nearly 25%. Under these conditions, it asks whether it intends to guarantee the effective application of conventional commitments relating to the revaluation of dispensing fees and whether it is envisaged to open, in conjunction with representatives of the profession and organizations such as Les Entreprises du medicinale, a global reflection on the evolution of the pharmacy economic model, in order to adapt the remuneration structure for the increase in cost of high-cost treatments and to secure the territorial network, particularly in rural or under-resourced areas.

Machine translation from French. The official text remains authoritative.

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