2024-11-08 14:59:00
A new decree requires doctors to justify the prescription of certain medications, particularly antidiabetics, to Health Insurance. Doctors denounce, among other things, an administrative overload when Health Insurance assures that this system will be “rapid” and “limited”.
“It will be extremely quick.” The general director of Health Insurance, Thomas Fatôme, tries to reassure doctors after the publication of a decried decree, last October 30, asking healthcare professionals to justify the prescription of certain medications. A justification which aims to allow Health Insurance to verify that this prescription corresponds to the therapeutic indications established by the High Authority for Health (HAS). And therefore it is eligible for reimbursement for the patient.
Many unions and doctors denounce an additional administrative burden. “This is not the time to add more paperwork to us in the current demographic context,” said Jean-Christophe Nogrette, president of the MG France union, to BFMTV.com.
The union French Union for Free Medicine (UFMLS) also deplored in a press release an “overload of administrative work” while “doctors have the greatest difficulty in meeting demands for care” and “seven million French people do not have a treating doctor”.
“It’ll take less than a minute.”
The general director of Health Insurance, Thomas Fatôme, assures BFMTV that the system will be “very simple” while admitting that the “operational implementation” is still under discussion.
“The doctor will access the Amélie pro portal, which he goes to almost every day, he will check a few boxes in order to answer three or four questions, it will really take him less than a minute,” assures -he.
Before adding: “Then, he will give the patient a document restoring this (or indicate it on the prescription, Editor’s note), with which the patient can be reimbursed by the pharmacist.”
Thomas Fatôme would like to point out that the scope of the regulations concerned will be “extremely limited”. “It’s not a question of getting the daily prescription from doctors,” he emphasizes. “In a very concrete way, the classes of drugs that we are targeting concern three prescriptions per year per general practitioner.” Please note that the list concerned has not yet been published in the Official Journal.
Antidiabetic drugs in the viewfinder
In the viewfinder are especially antidiabetic drugs, such as Ozempic or Trulicity, sometimes misused for weight loss purposes. The decree thus aims to avoid “misuse”. For this type of medication, the doctor will have to say, for example, whether the person is over 18 years old, whether they have type 2 diabetes or whether they are taking other medications related to this disease.
“Today misuse remains limited but given the effect of these drugs on weight loss, we know that if tomorrow we do not regulate, this misuse can increase extremely easily”, justifies Thomas Fatôme.
Another example: Versatis, a pain relief patch which is only covered in cases of shingles. When the prescription is not given due to shingles, the doctor is already supposed to indicate on the prescription that the medication “is not reimbursable.” “It is indeed a problem when doctors do not do it,” underlines the president of the Liberal Doctors union, Sophie Bauer, to BFMTV.com.
“Patient needs” “reduced” to “simple recommendations”
Other discontent from doctors: that this decree was signed by the Prime Minister without prior consultation with the unions. Or even that this decree prevents them from adapting prescriptions to the needs of their patients. “It is revolting and anti-ethics to reduce the care needs of our patients to simple recommendations from HAS experts, even though some disagree with learned societies,” said the UFMLS press release.
There is also concern that doctors refuse to use certain medications to avoid administrative burden even though they are necessary for the health of certain patients.
“But this is perhaps ultimately the desired goal: to complicate the lives of prescribers to such an extent that they abandon “dangerous” molecules,” says Richard Talbot, treasurer of the Fédération des Médecins de France (FMF), on the Federation website. The latter considers that this decree aims above all to “save money”. To which Thomas Fatôme admits half-heartedly to our microphone, emphasizing that these prescriptions are “economic issues but also public health”.
Medical confidentiality in danger?
Doctors also point out the risk of breach of medical confidentiality. The president of the UFMLs, Jérôme Marty, speaks in the columns of the regional daily The Dispatch, of “the end of medical confidentiality” given that it is necessary to “prove the reason for a prescription”.
“Doctors will now have the obligation to disclose medical information to the administration,” regrets Marseille doctor Amine Ayari on X.
What the director of Health Insurance refutes: “there is absolutely no problem of medical confidentiality”, he declares. The decree specifies that “only the medical control department of the fund (Health Insurance, Editor’s note) can have knowledge of the information covered by medical confidentiality”.
If Thomas Fatôme assures that this system “is not intended to become generalized”, the draft Social Security budget for 2025 (PLFSS), currently being examined in Parliament, plans to extend this procedure to transport requirements patient and medical analyses. “There may also still be extremely targeted issues,” he defends, calling for “waiting for the outcome of the debates.” “We will have the opportunity to discuss with the doctors,” he says. “See you at the beginning of next year to try to work on the implementation of this system.”
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**Interview with Thomas Fatôme, General Director of Health Insurance**
**Interviewer:** Thank you for joining us today, Mr. Fatôme. With the recent decree requiring doctors to justify the prescription of certain medications, many healthcare professionals have expressed concerns about an increased administrative workload. Can you explain the rationale behind this change?
**Thomas Fatôme:** Thank you for having me. The primary goal of this decree is to ensure that prescriptions align with the therapeutic guidelines established by the High Authority for Health. This helps us verify the appropriateness of the medications being prescribed and ensures that patients receive care that is both effective and eligible for reimbursement. We understand that it may seem like an added burden, but we believe it will ultimately improve patient safety.
**Interviewer:** Critics argue that this new requirement adds unnecessary paperwork for doctors, particularly at a time when the healthcare system is already stretched thin. How do you respond to that?
**Thomas Fatôme:** I recognize those concerns and want to emphasize that the process is designed to be very simple and quick. Doctors will access the Amélie pro portal, answer just a few questions, and it should take less than a minute. The scope of this regulation is also limited — it primarily focuses on just three prescriptions per year per general practitioner concerning specific medications.
**Interviewer:** One of the medications targeted by this decree is Ozempic, often misused for weight loss. Can you elaborate on the measures in place to prevent misuse?
**Thomas Fatôme:** Yes, the misuse of antidiabetic drugs for purposes other than their intended medical use is a significant concern. Under the new regulations, doctors will need to confirm specific criteria, such as the patient’s diagnosis of type 2 diabetes and their age, before prescribing these medications. Our aim is to curb misuse and ensure patients receive the treatments they need without compromising safety.
**Interviewer:** There are also claims that this decree was implemented without prior consultation with medical unions. Why was that approach taken?
**Thomas Fatôme:** While we strive for collaboration with medical unions, the urgency of this issue necessitated prompt action. The oversight we’re implementing is critical for managing healthcare costs and ensuring appropriate drug use. However, we are open to dialogue with healthcare professionals moving forward to refine the process.
**Interviewer:** Some doctors fear that this requirement could lead them to avoid prescribing certain necessary medications to cut down on administrative hassle. What assurances can you provide them?
**Thomas Fatôme:** I want to reassure doctors that the intent is not to discourage them from prescribing essential medications. The feedback from healthcare providers is valuable, and we will continue to review and adapt our processes to support them while maintaining patient care standards. Ultimately, we share a common goal: to provide the best care for patients in a sustainable manner.
**Interviewer:** Thank you for your insights, Mr. Fatôme. It’s clear that this is a complex issue with many stakeholders involved, and we appreciate your time today.
**Thomas Fatôme:** Thank you for the opportunity to discuss these important matters. We’re committed to ensuring that the healthcare system works for everyone involved.
