Nirsevimab (Beyfortus), this monoclonal antibody intended to immunize babies against respiratory syncytial virus (RSV), will no longer be 100% reimbursed, pushing too many parents to give it up, the main pediatrician organizations regretted on November 20 French.
« This decision to limit reimbursement appears incomprehensible and inadmissible. », estimate in a joint press release several organizations*, including the French Society of Pediatrics (SFP) and the French Association of Ambulatory Pediatrics (Afpa). Beyfortus is part of a series of innovative treatments which aim to prevent or limit RSV infection, the main virus responsible for bronchiolitis.
The epidemic has already started this year in mainland France, currently affecting the Paris region and Hauts-de-France according to the latest weekly report published on November 20 by Public Health France, even if it remains moderate in scale compared to in previous years.
Beyfortus (from the AstraZeneca and Sanofi laboratories) had already been offered last year to many infants. At the time, the costs were covered by the State which had directly purchased doses from the laboratories. But this year, the treatment is moving to more traditional reimbursement, via Health Insurance. And this only reimburses it up to 30% in the city, the rest being the responsibility of mutual insurance companies.
A remaining charge of 300 euros for certain families
Or, “many families, unable to pay the remaining co-payment, around 300 euros, (report) that several mutual insurance companies do not reimburse or partially reimburse”emphasize the pediatricians. For comparison, many childhood vaccines are reimbursed at 65% and that against measles is fully reimbursed. Please note, as indicated on the Ministry of Health website, that the coverage remains full and without advance costs in the event of a hospital stay (birth in the maternity ward) and that in the city the medication is fully reimbursed with the Supplementary Supplement. solidarity health or State medical aid.
The lower reimbursement of Beyfortus, announced this summer, results from an evaluation by the High Authority for Health (HAS) which described its actual benefit as “moderate” and the improvement in actual benefit (ASMR) as “minor “. The institution’s Transparency Commission, which nevertheless maintains the indications already retained for reimbursement (newborns and infants in their first year of immunization, children up to 24 months vulnerable to severe RSV infection in their second year of circulation of the virus), details its analysis in an updated opinion dated October 23 and posted online on November 20.
For its evaluation, the HAS took into account the data recorded last season, showing a clear drop in hospitalizations thanks to Beyfortus. But she also notes a lack of conclusive data on the heaviest consequences for hospitals to manage, in particular passages in intensive care.
Sanofi estimated at the end of October that one in two eligible babies had already received Beyfortus. In addition, another preventive treatment is available, Pfizer’s Abrysvo, a vaccine administered to pregnant women and fully reimbursed as part of pregnancy care.
*Child health conference (Pr. Christèle Gras-Le Guen), National Professional Pediatric Council (Dr. Emmanuel Cixous-Dr. Fabienne Kochert), French Society of Pediatrics (Pr. Agnès Linglart, Prof. Romain Basmaci), French Association of ambulatory pediatrics (Dr Andreas Werner), French Society of Neonatology (Pr Marine Butin), French-speaking pediatric resuscitation and emergency group (Pr. Stéphane Leteurtre, Pr. François Dubos), Pediatric Infectious Pathology Group (Pr. Robert Cohen, Dr. Hervé Haas), Pediatric Society of Pneumology and Allergology (Pr. Harriet Corvol, Pr. Alice Hadchouel-Duverge)
