The conditions for prescribing and reimbursing drugs where generic alternatives are available have changed on 1er January 2020, as provided for in the Social Security Financing Act for 2019. Service-public.fr explains.
The limitation period
If the doctor wishes to prescribe a (original) originator medicine, the equivalent of which exists in the form of a generic, he must specify the indication on the prescription
non-substitutable
and the reason for his decision not to allow substitution by the pharmacist.
Three medical situations may justify this refusal and allow the use of the term
non-substitutable
:
MTE: When the patient is stabilized on a drug (restriction to certain active substances such as antiepileptics or immunosuppressants);
EFG: In children under 6 years of age, when no generic drug is appropriate;
CIF: if the patient has a formal and demonstrated contraindication to an excipient present in available generic medicinal products.
For the attention of pharmacists, an order of the Official Journal of 6 february 2020 introduced ae particulars to enable them to justify the supply of an originator medicinal product even where the doctor has not indicated the particulars
non-substitutable
:
MTE-PH: when non-substitution of a drug is justified by a narrow therapeutic margin.
The refund
If you accept the generic drug, the coverage doesn't change: you don't advance the fee and you don't have any co-payments.
If you have a prescription with a mention
non-substitutable
justified by one of the 3 criteria, the pharmacist will bill the originceps medicine on the basis of its reimbursement and you will be able to benefit from the third-party payment and not advance the costs.
If a person refuses the generic drug without presenting a prescription that includes a statement
non-substitutable
or if this statement is not correct, the pharmacist will dispense the originator medicine but you will pay for it all, without benefit of the third party. You will then have to send the paper care sheet to your health insurance fund which will reimburse it on a basis limited to that of the most expensive generic medicine in the corresponding generic group. If the price of the originator drug is higher than the price of the generic drug, you will bear a co-payment equal to the price differential.
This measure does not apply to lump sum liability (TFR) medicines.
Please note
The mention
non-substitutable
and its justification must appear on the prescription for each prescribed medicinal product and for each medical situation concerned.
