Question 18779 — maternity health insurance

Summary

Mr. Paul-André Colombani questions the Minister of Solidarity and Health about health insurance controls regarding ketamine treatments for patients with fibromyalgia. T2A checks are not checks on the appropriateness of care. However, through its medical advisors, the health insurance fund takes over the possibility of calling into question medical treatments. Indeed, Doctor Patrick Metais indicates that in February 2019 “during a health insurance check at the Bastia Hospital, the medical advisors decided to refuse funding for hospitalizations for the evaluation and treatment of chronic pain caused by fibromyalgia and treated with ketamine”. Conversely, the PACA and Corsica ARS validated this treatment by exemption in 2010 at the patient's home through retrocession. If this treatment does not still obtained marketing authorization, it has however been validated by numerous scientific works and by the health authorities, and in particular by the National Agency for the Safety of Medicines and Health Products in 2010. He questions it on the appropriateness of the decision given to the health insurance fund to call into question the reimbursement of an innovative treatment for pain in CH, a treatment that is otherwise authorized at the patient's home and validated by the health authorities, and for which the only alternative would be opioid treatments.

Machine translation from French. The official text remains authoritative.

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