Parents have to pay up to 300 euros to vaccinate their baby. Incomprehensible for the pediatric community and penalizing for the most modest families, Occitanie has just been placed on bronchiolitis epidemic alert this Wednesday, December 4, according to Public Health France.
“Last year, the treatment was not available, but it was 100% reimbursed. This year, it is available, but health insurance only covers 30%.” : the bronchiolitis epidemic, which has until now spared Occitanie, arrives in the region in a controversial context over access to Beyfortus, the preventive treatment now available to protect babies.
In its bulletin of December 4, Santé Publique France placed the region in “red” for the first time this fall.
Brigitte Virey, national president of the pediatricians’ union, poses the debate, a dilemma for parents relayed by the pediatric community: “Restricting access to nirsevimab (better known to the general public under the name Beyfortus), by limiting its reimbursement appears unacceptable for learned pediatric societies, who believe that it is essential, from an ethical and scientific point of view. public health, to protect all infants and newborns, including the most precarious and vulnerable”, are concerned, in a joint declaration, those involved in pediatrics, who want to avoid “avoidable hospitalizations”.
With a European marketing authorization since October 2022 and available a year later, Beyfortus has revolutionized the management of bronchiolitis: in 80% of cases, an injection prevents RSV, respiratory syncytial virus, “at the origin of 80% of bronchiolitis, infecting the body of newborns”specifies health insurance on its site.
Beyfortus is effective a few days after an injection. Health insurance praises its effectiveness against serious cases, based on a study conducted by the Pasteur Institute and Public Health France: 5,800 hospitalizations avoided between September 15, 2023 and January 31, 2024 in France.
“In “real life”, it works”
“It’s an observation that we make in our “real life” as doctors, Beyfortus, it works!”insists Brigitte Virey, who recalls that if the vaccination is not carried out at the maternity ward, the remainder payable by the parents is around 300 euros“not all mutual insurance companies cover it, and we are unable to specify which ones”insists the pediatrician, who is surprised by the weakness of the support: the reimbursement rate depends on the medical service rendered, it is 100% for medications classified as irreplaceable and expensive, the base of 30% corresponds to an efficiency “moderate”.
“Incomprehensible”for Brigitte Virey, who emphasizes that all childhood vaccines are much better reimbursed, “100% for MMR, 65% for others”.
“This story of medical service rendered raises questions for us,” concludes the pediatrician, who is concerned about a “renunciation of care” : “I contacted the general management of healthcare provision, they are reviewing their position for next year.”
In the meantime, parents of babies are penalized, and pharmacists sometimes navigate by sight: “It is impossible to know if policyholders will be reimbursed by reading their mutual insurance card” regrets Christelle Quermel, pharmacist in Montpellier, and president of the Hérault pharmacists’ union, who discovered this problem of out-of-pocket expenses this week, while “many families” wanted to protect their child before the arrival of the winter epidemic.
A mother who had ordered the vaccine gave up when she discovered that it would cost her 300 euros. “I said to him, ‘Are you sure?’ It’s incredible, when the vaccine is effective”the pharmacist says.
