E-drug: France to promote sales of generic drugs (cont'd)
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Dear E-druggers,
Hilbrand was asking why the drug use in France differs from
neighbouring countries. Well I am not sure it differs that much from
Italy, Spain and Switzerland, but from the Netherlands, yes. I have
no in-depth knowledge of the French system or market, but thought
I would quote from a report. This report is mentioned in Scrip 19
September. The report is from the Audit Court and criticizes the
government for having failed to take any effective action to curb
the rise in pharmaceutical spending. Here are some excerpts:
- a government unwilling to act decisively for fear of alienating
doctors and patients and damaging the interests of certain sections
of the pharmaceutical industry
- a pharmaceutical industry being accused of monopolising
information to doctors and seeking approval of new presentations
and indications of its products in order to ward off competition,
thereby contributing to the 'inexorable' growth in the
pharmaceutical market
- France spends more of its domestic product on medicines than
any other country in the world (2.1% against US 1.5%)
- some classes of products, like vasodilators, are overconsumed,
while others are probably underconsumed
- in 1998 the government set out a medicines policy intended to
improve the use of medicines and control pharmaceutical spending.
None of the provisions aimed at rational drug use was implemented
- in most cases all that has happened is that products judged to
have a low medical benefit have had their reimbursement level
reduced, e.g. vasodilators from 65% to 35%, or prices cut by an
average of 7%.
- there is no public funding for information and training for doctors
- there is no postmarketing evaluation
In another Scrip note 14 September a letter is quoted which has
been sent from the French regulatory authority to doctors stressing
the importance of prescribing benzodiazepines correctly, because of
the risk of dependence and abuse. Now those of us following the
field of how to change prescribing habits know well that letters
from the authority have very limited effect if any at all, except
when followed by regulatory actions such as changing a drug to
another schedule.
A study has also been published on the consumption of three
benzodiazepines suggesting that most patients take them in too
high doses for too long and develop a high degree of dependence.
France is the leading consumer of psychotropics in Europe. Even
this report advices to address the problem by targeting doctors and
patients, stressing the adverse effects of benzodiazepines and to
remind doctors of the need to follow prescribing guidelines. Again,
in my opinion, not enough to change prescribing habit.
In 1996 the French government published a decree on proposed
financial penalties for doctors who do not respect treatment
guidelines or who prescribe a product outside its approved
indications. I do not know if this was put in place, but again, fines
are not likely to have the desired effect, they only annoy people.
Some kind of incentives, not necessarily financial, are needed. As
are education, guidelines and other forms of academic detailing.
In 1998 the French government ordered a report from a new
prescription monitoring body to look into the following areas where
the government suspected overconsumption: antibiotics,
vasodilators, vein tonics, antihypertensives, psychotropics and
hypolipaemics.
During these years, there have been several news items on actions
by the government to cut or curb prices. France also received some
publicity when it negotiated with GSK for more than a year about
the price on the anti-migraine product Imigran (sumatriptan) before
accepting it for reimbursement. When Pierre says prices now are
average European for new products, part of the reason for that is
that the industry now prices new products similar in all European
countries to avoid parallel importing.
All in all, for someone outside looking in, it seems that the French
government has been more interested in curbing prices than
improving prescribing, which might be one reason for the high
consumption. I also suspect France may have many single
practices, i.e. doctors working alone? In countries with a model of
group practices, prescribing seems to be different.
By the way, the French prescribing habits also spread to
Francophone Africa and they used (may be even still use) several
French made products, often combination products, which are
without competition because no other countries use them and they
are not manufactured by international generic manufacturers. One
example would be special corticosteroid products. Hence they pay a
high price. They could all be substituted for well known essential
drugs.
Kirsten
Kirsten Myhr
Head of Eastern Health Region Drug Information Centre
RELIS Ost
Ulleval University Hospital
0407 Oslo, Norway
Tel.: +47 23 01 64 11(o) Fax: +47 23 01 64 10
+47 22 56 05 85 (h) mobile: +47 416 38 747
myhr@online.no (h)
kirsten.myhr@relis.ulleval.no (w)
www.relis.no
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