Reimbursement, complex financial equation security: This article explores the topic in depth.
Nevertheless,
Reimbursement. Similarly, complex financial equation security:
The possibility of a reimbursement in France of new treatments against obesity, such as the Wegovy of Novo Nordisk and the Mounjaro of Eli Lilly, raises strong questions as to their impact on the finances of health insurance. Similarly, If these drugs in the class of GLP-1 analogs promise significant weight loss for thousands of patients. However, their high cost and the chronic nature of obesity pose a major economic challenge for the French health system.
Marketed since 2024 in France without being reimbursed. Therefore, these treatments are currently being covered by certain private insurance in the United States, but their reimbursement remains exceptional in Europe. Similarly, The High Authority for Health (HAS) nevertheless paved the way for a potential management in October 2024. In addition, under very strict prescription conditions, targeting people with severe obesity.
Tense negotiations and an uncertain calendar
Pharmaceutical laboratories, aware of the stake, claim their determination to obtain a rapid refund. However, Novo Nordisk says “Mobilized. For example, determined” For Wegovy, while Eli Lilly filed a new reimbursement request for Mounjaro in April, whose evaluation is expected “In the coming months”. The two giants also undertake to guarantee the supply of the French market. even with the expansion of prescription power to all doctors.
However, discussions around the price promise to be complex. The Economic Committee for Health Products (CEPS). the public body responsible for negotiating the prices of reimbursed drugs, must achieve an agreement with manufacturers. Virginie Beaumeunier. president of the CEPS, underlined the need to take into account not only the potential economies linked to the reduction of comorbidities (cardiovascular diseases, diabetes, cancers) but also the duration of treatment-potentially for life-as well as the undesirable effects and the observance of patients.
A financial burden for reimbursement, complex financial equation security social security?
The question of financial sustainability is at the heart of concerns. The Committee of Experts responsible for monitoring health expenses recently alerted to a “Serious risk” overcoming the health insurance budget in 2025. especially due to“Savings not made on reimbursement of drugs”. Obesity. described as chronic disease by nutrition professor Judith Aron, requires long -term treatment, as the stopping of drugs causes weight recovery.
According to the HAS projections of October 2024, the population eligible for Wegovy in France is between 1.05 million and 2.1 million patients. The National Health Insurance Fund (CNAM) acknowledges that it is “Complex. premature to carry out reliable estimates on the impact in terms of reimbursement of these products”the price is not yet defined.
Investment in prevention in the face of treatments costs
Paradoxically. the Organization for Economic Cooperation and Development (OECD) estimates that each euro spent for the prevention of obesity generates 6 reimbursement, complex financial equation security euros of return on investment. In France, the cost of obesity (reimbursed care and absenteeism at work) is estimated at 12.7 billion euros. could exceed 15 billion euros in 2030, according to a study by the Asétérès mandated by Novo Nordisk.
The final decision concerning reimbursement is expected in “fall”. after a medico-economic assessment which will determine the real impact on health insurance spending. Grégory Emery. Director General of Health, recalled in March that the absence of agreement on the price is explained by an excessive difference between the claim of the State and that of the industrialist. The outcome of negotiations will be crucial for access to these treatments and for the balance of social security accounts.
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