Question 17371 — pharmacy and medications

Summary

Mr. Jean-Pierre Door draws the attention of the Minister of Solidarity and Health to the lack of equitable access to hospital innovations due to the additional criteria for inclusion on the list. In health establishments, the additional list allows coverage by health insurance of pharmaceutical specialties, for certain of their therapeutic indications, in addition to hospitalization rates, when these indications present an innovative character. This list, which is subject to regular updates, is established by order of the ministers responsible for health and social security and specifies only the indications concerned, in accordance with article L. 162-22-6 of the social security code. The inclusion of an innovative product on the list is additionally subject to its level of evaluation by the High Health Authority. This product must obtain, in more than its level of medical service rendered (SMR), a level of improvement in medical service rendered (ASMR). If they do not achieve this level of ASMR, they will not be registered or supported. Thus, the ASMR designed as an indicator to help set the price is diverted from its original objective, because it is used in the context of the list in addition as a criterion for access to reimbursement. Medicines reserved for hospital use and Innovators benefiting from a significant SMR are then refused their registration on this list, which deprives private patients of these innovations. This is therefore a break in equality compared to patients treated with products available in town for which only the SMR is a criterion for access to reimbursement. This worrying situation, which concerns in particular anti-cancer products, contravenes the cancer plan III of which one of the objectives aims to fight against inequalities and loss of opportunity for patients. He asks her how she intends to change the criteria of the list in addition to re-establish a fair situation of patient access to innovative products in the city and in hospitals.

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