OBJECTIVES : The expensive drug list is a derogation measure to the DRG hospital reimbursement system to finance all the drugs included on the positive list “liste en sus” (LES). The main purpose of the study was to describe the reimbursement evolution over the time

METHODS : All the drugs included in the LES list were extracted from French claims database detailing drugs reimbursement at national level (FICHCOMP) between 2016 and 2018. Geographic repartition, and treatment classification were analysed.

RESULTS : In 2018, the NHI reimbursed 3,6 billion euros for 562 million prescriptions delivered in France. Between 2016 and 2018, reimbursement increased for all drugs by 15%, mostly driven by the increase of oncology drugs (+32%) and decrease on non-oncology (-6%). The all drugs reimbursement increase was mainly observed between 2016 and 2017 with +13% vs +1% 2017/2018 and mostly driven by oncologic drug with +22% in 2017/2016 and +8% in 2018/2017.

Among the non-oncology drugs, the decrease is mainly driven between 2016/2018 by the following disease conditions, diagnostics (-97%), cardiology (-74%), ophthalmology (-55%), anti-infectious (-21%). However, we observed an increase of the following non oncologic condition for diabetes (+44%) and neurology (+7%).

Between 2016 and 2018, the patient number who received at least one expensive drug increase of +9% (310,774 patients in 2018), mostly driven by males +11% versus +7% by females, and also driven by oncologic drugs patients number (+17%) vs +0.5% for non-oncologic.

The turnover of drug is very low, with 27 drugs removed in 2016 (8% of all drugs), 1 in 2017 (0.3%) and 9 (2%) in 2018 versus 49 (15% of all drugs) inscribed in 2016, 38 (11%) in 2017 and 43 (11%) in 2018.

CONCLUSIONS : The reimbursement dynamic of LES is growing considerably over the time, mainly driven by oncologic drugs. Turnover of innovative drugs inscribed is not well observed.