During 2002-6, a total of 1 billion euros was “wasted” by the French health care system as a result of physicians prescribing branded rather than generic drugs in just five classes of medicines under pressure from company representatives, claims a report by the national consumer group Union Federale des Consummateurs – Que Choisir (UFC-QUE CHOISIR).
The drugs – used in the treatment of gastroesophageal disorders, blood pressure and arthritis, plus anticoagulants and antiplatelet agents for use in prevention of cardiovascular attacks – account for 14% of prescriptions written by French GPs each year, says the consumer group. In particular, it points to government estimates that in 2002 alone, 50% of French prescriptions for Sanofi-Aventis/Bristol-Myers Squibb’s antiplatelet drug Plavix (clopidogrel) were “unnecessary or misprescribed,” costing the system 70 million euros annually or 350 million euros during 2002-6. French health service spending on antiplatelet and anticoagulant agents increased 88% in this period, it adds.
In France, company reps are permitted to visit doctors only – not pharmacists or drug distributors or wholesalers – and physicians there come under greater detailing pressure than anywhere else in Europe, says UFC-QUE CHOISIR. A report from the Ministry of Labour’s General Inspectorate of Social Affairs (IGAS) has estimated that, in 2005, 22,702 sales reps were operating in France, or one for every nine doctors. This is twice as many as in the UK and Germany and four times as many as in the Netherlands, says IGAS, which estimates that this level of detailing costs the industry the equivalent of 25,000 euros per doctor.
Moreover, France provides the lowest levels in Europe of pharmacology training for its medical students, while under new public health legislation, 90% of French doctors’ training and continuing education in the area of medicines is now funded by the industry, says the consumer association. To rectify the situation, it is calling on the Health Ministry to establish a force of 1,700 public medical visitors, under the control of the National Authority for Health (HAS), which would provide “objective” alternative information on medicines to that which is supplied by the company reps. This initiative would cost an estimated 200 million euros annually, and this could be funded by taxes on pharmaceutical companies’ marketing activities, says UFC-QUE CHOISIR.
Until this can be achieved, the government should raise taxes on drug promotion and take steps to reduce company reps’ visits to doctors where these relate to the most “problematic” drugs, the group proposes.
Historically, France’s use of generics has been very low; in 2001, the social security administration reported that they accounted for just 3.1% of all drug sales in the country. Since then, government measures to encourage generics have had some success, and in 2007 their retail sales reached $3.7 billion, or 8.6% of the total drug market by value and around 18% by volume. The generics market is still under-developed compared with Germany and the UK, but market researcher Espicom has forecast that government cost-cutting initiatives will help it grow 15% in each of the next five years to reach a value of $7.4 billion in 2012, by which time generics will account for 15.5% of the total national pharmaceutical market.
