As the presidential election approaches,
20 Minutes
looks at certain health measures promised by Emmanuel Macron.
The 2017 candidate had promised to implement unit sales of drugs.
If a decree has just passed in February 2022, authorizing this unit delivery, it is very limited, because it is based on the voluntary work of pharmacists, the pricing seems low to them and it will only concern certain antibiotics.
“Currently, one medicine out of two is not consumed, with a risk of self-medication and environmental impact.
This leads to a waste of 7 billion euros per year: we will therefore generalize the sale of drugs by the unit.
»
It is not the candidate Macron of 2022 who writes these lines, but that of 2017… Five years later, has Emmanuel Macron kept his word?
On the unit sales front, things are moving… belatedly and partially.
1.5 kg of medicine wasted per French person on average
Indeed, since a decree published Thursday, February 3, 2022, pharmacists can deliver certain antibiotics to the unit.
The objective is threefold: economic, ecological and public health.
Indeed, each year, a French person wastes an average of 1.5 kg of medicines.
These are all pills that are expensive for the community… and that risk ending up in nature.
But the question also relates to compliance (compliance with a doctor's prescriptions).
It often happens that a patient who should take seven days of antibiotics stops after five… and reuses these drugs a year later, when he falls ill again.
Thus risking poisoning yourself with expired tablets… A study by Inserm published in 2017 revealed obvious benefits.
Between November 2014 and November 2015, 100 volunteer pharmacies sold 14 antibiotics to patients.
Results ?
“The unit delivery mode allows a reduction of around 10% in the volume of tablets delivered compared to a traditional sale”, underlines the report.
A debate around the remuneration of pharmacists
But in reality, the executive is far from having applied this measure as it is.
Article 40 of the Law on waste and the circular economy, promulgated on February 10, 2020, provides "that the delivery of certain drugs in pharmacies can be done individually for some antibiotics, for which the interest of a unit dispensation is the most obvious”.
First limit: timing.
Today, this is still not the case.
Indeed, pharmacists and Health Insurance have been in the midst of conventional negotiations since October and until last week.
We can therefore assume that the campaign promise will be kept by the first round of the presidential election.
At least partially.
Because on the table, there is in particular the question of remuneration for pharmacists.
For the moment, the new agreement provides for a pricing of 1 euro for any dispensing of a unit drug.
Because the health professional will have to cut the blister to find the appropriate dose, photocopy the instructions, necessary for the patient.
And put it all in a bag.
Ongoing negotiations with the unions
However, many believe that this price is too low.
And for the moment, the pharmacist has no obligation to embark on unit dispensing, since it is on a voluntary basis... Philippe Besset, pharmacist and president of the Federation of community pharmacies, was at the negotiating table and will call on his union to say yes to this measure, synonymous with a small revolution for his profession.
“Me when I sign, I do, he assures.
But I think the pay is very low.
So I doubt that many pharmacists will commit.
“Waits for him to see in a year if in his pharmacy, he is a loser.
“At least, we pose the debate.
I agree to play the game, but it must be done over the long term.
If I can't pay someone more, I'll have to choose between unit delivery or vaccinating.
For Christophe Le Gall, president of the National Union of Pharmacies of France, the remuneration is too low for the profession to embark on the adventure.
“The responsibility for the drug is borne by the manufacturer who manufactured it and put it in a box.
But from the moment the box is opened, the pharmacist becomes responsible.
This compensation for work and liability is not reasonable!
»
Why only for antibiotics?
Second obstacle: unit dispensing should be done only for certain antibiotics and not for all drugs.
“We are going to start with two classes of drugs: one that we already do, narcotics (based on morphine, opioids, etc.) and secondly, critical antibiotics, on a list that will be provided to us by the general management of health", explains Philippe Besset.
A first step that makes sense to him.
“A morphine drug in a medicine cabinet is dangerous, a kid who falls on it, he dies.
As for antibiotics, it's not good to self-medicate with them.
»
A false good idea " ?
Philippe Besset does not hide his reluctance.
“There is an interest for health reasons and for the preservation of nature.
But there is no economic sense in delivering to the unit.
Because most of the drugs we sell are only worth a few cents, often cheaper than the packaging!
Health insurance will have to pay preparers to cut blisters [packaging].
“Especially since “the packaging of the drug is often adapted to the pathology”, adds Christophe Le Gall.
Indeed, normally the box is produced according to its marketing authorization (AMM): for an antibiotic, for example, it will be sold in boxes of 14 because seven days of treatment are planned.
Unsurprisingly, the Leem, the representative of the drug companies, does not go out of its way to express its opposition.
In a press release, baptized a “false good idea”, he underlines: “the dispensing of drugs to the unit is not a relevant response to waste.
Waste comes from inappropriate prescribing and poor patient compliance.
However, the United States, the United Kingdom and Canada have adopted this model of unit delivery for decades.
"But we don't change so easily from one model to another," criticizes Philippe Besset.
To impose it on all medicines, it would be necessary to change the entire pharmaceutical industry, all French pharmacies.
Either a small note of 2 or 3 billion euros... "In the meantime, a useful reminder: instead of throwing away your expired pills,
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Emmanuel Macron
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Presidential election 2022
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