France and the Challenge of High-Cost Innovative Drug Expenditures in Hospitals
Author(s)
Oriane Jouhet, PharmD, Marion TANO, PharmD, VIRGINIE SIORAT, PharmD, MATTHIEU RIBAULT, Data engineer, OLIVIER PARENT DE CURZON, PharmD, PASCAL PAUBEL, PhD, ALBANE DEGRASSAT THEAS, PhD.
AGEPS - APHP, PARIS, France.
AGEPS - APHP, PARIS, France.
OBJECTIVES: In France, access to high-cost innovative medicines in hospitals relies on a supplementary reimbursement list over DRG payment system, called liste en sus (LES). Designed to ensure equal access to therapeutic innovations, this mechanism now accounts for nearly 20% of national pharmaceutical expenditure. This study assessed LES spending trends from 2019 to 2024 in France in order to identify actionable levers to improve sustainability.
METHODS: A retrospective, descriptive analysis was conducted using SCANSANTE (ATIH) data covering LES expenditures in public and private hospitals from 2019 to 2024. Data were analyzed by anatomical therapeutic chemical classification, drug type (Advanced Therapy Medicinal Product or not), biosimilars and generics, market exclusivity status and time since LES inclusion (<5, 5-10, > 10 years). Indicators included annual spending (€), market share (%), volume trends (units) and weighted annual average price (WAP). An index decomposition approach (volume (Iv), price (Ip) and structural (Is)) identified expenditure growth drivers.
RESULTS: Between 2019 and 2024, LES-related expenditures nearly doubled, from €3.9B to €7.5B. Growth was driven by exclusive drugs (91% of 2024 spending), particularly antineoplastics (76% in 2024) and ATMPs (€25M in 2019 to €256M in 2024). Spending is attributable to a volume growth (+60,6%) and structural effect (+42,9%). Products listed for <5 years saw a +230% rise in WAP (from €3.660 in 2019 to €11.898 in 2024 in average). Those listed for 5-10 years also increased from €1.071 to €3.917. Thanks to the high adoption rates (97%), market access of biosimilars generated €390M in savings.
CONCLUSIONS: LES spending growth is mainly attributable to recent, expensive drugs, whose prices are negotiated at national level and whose volumes are controlled by the assessment of indications that have demonstrated added value. These dynamics raise the question of whether a supranational regulatory framework might be needed to ensure long term sustainability.
METHODS: A retrospective, descriptive analysis was conducted using SCANSANTE (ATIH) data covering LES expenditures in public and private hospitals from 2019 to 2024. Data were analyzed by anatomical therapeutic chemical classification, drug type (Advanced Therapy Medicinal Product or not), biosimilars and generics, market exclusivity status and time since LES inclusion (<5, 5-10, > 10 years). Indicators included annual spending (€), market share (%), volume trends (units) and weighted annual average price (WAP). An index decomposition approach (volume (Iv), price (Ip) and structural (Is)) identified expenditure growth drivers.
RESULTS: Between 2019 and 2024, LES-related expenditures nearly doubled, from €3.9B to €7.5B. Growth was driven by exclusive drugs (91% of 2024 spending), particularly antineoplastics (76% in 2024) and ATMPs (€25M in 2019 to €256M in 2024). Spending is attributable to a volume growth (+60,6%) and structural effect (+42,9%). Products listed for <5 years saw a +230% rise in WAP (from €3.660 in 2019 to €11.898 in 2024 in average). Those listed for 5-10 years also increased from €1.071 to €3.917. Thanks to the high adoption rates (97%), market access of biosimilars generated €390M in savings.
CONCLUSIONS: LES spending growth is mainly attributable to recent, expensive drugs, whose prices are negotiated at national level and whose volumes are controlled by the assessment of indications that have demonstrated added value. These dynamics raise the question of whether a supranational regulatory framework might be needed to ensure long term sustainability.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HPR100
Topic
Health Policy & Regulatory, Health Technology Assessment, Real World Data & Information Systems
Topic Subcategory
Insurance Systems & National Health Care, Public Spending & National Health Expenditures
Disease
No Additional Disease & Conditions/Specialized Treatment Areas