Doctors will now have to justify themselves to Health Insurance for patients to be reimbursed

Doctors will now have to justify themselves to Health Insurance for patients to be reimbursed
Doctors will now have to justify themselves to Health Insurance for patients to be reimbursed

On October 30, Michel Barnier signed a decree for better control of Health Insurance reimbursements, which requires doctors to justify themselves to the organization regarding their prescriptions.

The reimbursement of certain medications by Health Insurance will now be subject to the obligation for health professionals to mention the “circumstances” and “prescription indications”. This decision comes from a decree signed on October 30, 2024 by the Prime Minister, published the next day in the Official Journal.

Lots of information required

An article of the law of December 26, 2023 submits “coverage by Health Insurance of a health product and its possibly associated services” at the mention “on the prescription or on a form provided for this purpose by the health professional of elements relating to the circumstances and indications of the prescription”.

This obligation will apply “when this product and, where applicable, its associated services present a particular interest for public health, a financial impact on health insurance expenses or a risk of misuse”according to information relayed by our colleagues at Thanks for the info.

The doctor who takes care of you must then enter this information either on the prescription, or on a specific document which must be attached to the prescription and accessible by teleservice, indicating “if the prescription complies with the indications giving entitlement to reimbursement” or to “recommendations from the High Authority for Health (HAS)”.

Anger among doctors' unions

This decision by the government aroused anger among certain doctors' unions. Application of these rules “will directly aggravate the difficulties of access to care and increase the loss of opportunities for patients due to an overload of administrative work, which is unjustified and time-consuming”estimates the French Union for Free Medicine (UFML).

The mechanism is intended to “restrict medical prescriptions”to the detriment of patients, says the union in a press release, calling “the profession to disobey”. Which medications will be affected? The National Health Insurance Fund (Cnam) wishes to target class antidiabetics “AGLP-1”tels that “Thezempic ou Trulicityq”said the general director of the organization Thomas Fatôme, according to BFMTV.

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