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  • This January 1, 2020, the rules surrounding the dispensing of generic drugs have changed.
  • The new system in force is fueling concerns and questions, some of them particularly dreading the “systematic” dispensing of generic drugs.
  • 20 Minutes takes stock of the concrete elements induced by this change.

Patients accustomed to favoring original drugs (or princeps) over generics risk having an unpleasant surprise during their first visit to the pharmacy this year. Because, since January 1, the rules for dispensing these brand-name drugs, which up to now could have been favored over generics thanks to a simple prescription marked "non-substitutable" (NS), have been considerably tightened.

This change raises as many concerns as more or less exact statements around generic medicines, these cheaper "copies" of already existing medicines whose patents have gone into the public domain (which makes it possible to reduce their selling price thanks to savings in research costs made by laboratories).

From January 1, 2020, the delivery of a generic drug becomes systematic.
The mention “non-substitutable” will not change anything, except for a few exceptions.
Attached is what pharmacists receive. pic.twitter.com/NAe3zWkHR6

- Christophe LAMARRE (@doclamarre) December 27, 2019

20 Minutes sorts the true from the false on this new device.

FAKE OFF

Has the delivery of a generic drug really become “systematic” since January 1?

Since 1999, pharmacies can substitute a generic drug for that prescribed on the prescription, "provided that this drug is in the same generic group and that the doctor has not excluded this possibility by the affixing of the handwritten mention" not substitutable "on the prescription", as recalled by the Health Insurance website.

However, since January 1, 2020, doctors can add this mention to a prescription only if they specify the medical reason behind their decision, which must comply with the very specific criteria provided for in the decree of 12 November 2019.

"Concretely, from now on, the proposal of generics by pharmacists must be systematic but the patient always has the right to take the reference drug [princeps] if he wishes" nuance Philippe Besset, president of the Federation of Pharmaceutical Unions of France (FSPF).

"With this change, the supply of generics is strongly encouraged by the government when there are no non-substitutable drugs according to the criteria now in force, which are very strict," agrees Gilles Bonnefond, president of the Union of community pharmacist unions (USPO).

My doctor: non-substitutable drug

The pharmacy: I give you the credits or we don't reimburse you

????????

- Fourmi Brion (@LolitaFourmi) December 18, 2019

Does the mention "non-substitutable" now only concern "a few exceptions"?

The decree of November 12, 2019 lists the three "medical situations" allowing doctors to use the term "non-substitutable": MTE, EFG and CIF. A "very reduced" list, according to Gilles Bonnefond and Philippe Besset.

“ETM [drugs with a narrow therapeutic margin] relate to few drugs, explains Philippe Besset. These include, for example, Levothyrox or medicines to avoid rejection after a transplant. The second case, the EFG, is that of generic drugs which would not have a pediatric form [and would therefore be unsuitable for a child]. You have to imagine an original drug available in syrup form but which, in generic terms, would only be in tablet form. Currently, this scenario does not exist, they necessarily have the same shape. So this is a situation that may exist in the future. ”

And to conclude: "The case of CIF is the most complex, it concerns proven allergies to excipients with known effects (EEN), according to a list defined by the health authorities, which we are still in the process of establishing but which concerns very few drugs. "

For its part, the National Health Insurance Fund (Cnam) tells us that "in some cases, for certain drugs considered" narrow therapeutic margin "(whose dosages are very finely adjusted), the pharmacist can deliver the drug princeps , even if this mention is not written on the prescription ”.

Does the refusal of a generic medicine prevent from now benefiting from third-party payment?

This is what many Internet users think, relaying an article with the worrying title: "From 2020, if you refuse a generic medicine, you will no longer be entitled to third-party payment".

However, the impossibility of benefiting from third-party payment in the event of refusal of generic drugs is nothing new, since it has been in force since 2012.

From 2020, if you refuse a generic medicine, you will no longer be entitled to third-party payment https://t.co/rlrJfsqOzb

- DI NATALE (@ DINATALE2) January 1, 2020

"The only difference with the situation in force before January 1, is that patients who refuse them will now be reimbursed on the basis of the price of the generic: the difference will therefore be at their expense", specifies Gilles Bonnefond. Whose union - like the FSPF - does not hide its reluctance towards the provisions that came into force at the start of this year: "Knowing that less than 10% of patients do not take generics in France, we are not not in favor of this measure, which will entail costs for patients and take a long time for pharmacists with a low return for the public authorities. "

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