What is France’s ‘franchise médicale’ fee and why might it go up soon?

France’s franchise médicale, the €0.50 paid on each box of medicine, or certain treatment sessions, could soon double in price, the government has suggested.

What is the franchise médicale?

The franchise médicale is part of the cost of prescribed medication, treatments such as a physiotherapy or speech therapy session, or a medical transport trip (however, the latter is charged at €2 per trip).

Introduced in 2008, it is part of the cost paid for by the patient, where applicable, for medicines that benefit from reimbursement by the French state.

It is charged by your caisse primaire d'assurance maladie and deducted from the amount reimbursed by the state. It does not affect the overall price that you pay at the pharmacy or healthcare facility.

Where upfront payment is not required (as is often the case for medicines) then the Cpam will take it off the next reimbursement you receive for a medical service for which you have to hand over money, such as a visit to a doctor.

It is not charged for medicine given during hospital treatment, paramedic care, or emergencies.

It only applies to prescription medication (as opposed to a box of medicine you can buy over the counter) that is otherwise reimbursed by the Assurance Maladie. It also only applies to medicine prescribed to people aged 18 and over.

• For example, you buy a box of medicine that costs €10, which is reimbursed at 65% by the Assurance maladie.
• You receive €6 back, not the full 65% (€6.50) because €0.50 is your franchise médicale charge.

You can see your franchise médicale charges itemised in your Assurance maladie online account at Ameli.fr.

Currently, the charges are capped at €50 per patient per year. They cannot cost more than €2 per day per treatment session, or €4 per day for medical transport (one return journey, costing €2 each way).

They are not usually reimbursed by top-up health insurance policies.

‘No sense of responsibility’

But now Economy Minister Bruno Le Maire is considering raising the cost.

There is no definite plan yet, but raising the fee would save public money, and encourage people in France to think twice before taking medicines they may not necessarily need, the minister said.

People in France are among Europe’s biggest consumers of medicine. And, since the start of the year, state reimbursements for medicines have increased by 7.5%. Doubling the amount to €1 per box or bottle could save the state €500million to €600million per year.

Mr Le Maire said: “Free or virtually free medication can lead to patients not feeling any sense of responsibility, which explains why the cost of medicine is still so high in France.”

The measure is one of the suggestions to come out of the Assises des finances publiques meetings, at which several ideas are proposed to the executive. Social security spending has been high on the agenda, as it represents half of the state’s total public spending.

One pharmacist said that increasing the franchise médicale could help if it addressed the ongoing shortages of certain medicines. “People sometimes buy too many [packs of medicines], and then bring them back to us,” she told BFM/RMC. “Imagine how frustrating that is when the products are in short supply.”

‘A nonsense cost-saving measure’

However, Frédéric Bizard, a health economy specialist, said the measure would have little effect on making people feel more responsible for the number of medicines they buy.

He said: “This is a cost-saving measure…It doesn't make sense in terms of health policy, it only makes sense in terms of budgetary policy.”

The suggested measure is just one idea intended to help the government save on healthcare costs and comes after ministers announced that dental care in France would now only be reimbursed to 60%, down from the current 70%.

Former health minister François Braun suggested earlier this year that the state could increase the price of generic medicines, in a bid to combat shortages and deter people from taking excess medication.

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