PDG58 THE IMPACT OF ECONOMIC REGULATION ON EXPANSIVE DRUG LIST IN FRANCE BETWEEN 2008 AND 2018

Abstract

The expansive drug list is a derogatory hospital reimbursement system to the DRG payment set up by the Social Security Financing Act (LFSS) of 2004 which allow to finance all the drugs inscribed on the positive list “liste en sus” (LES). The high budget of that liste en sus growth more than 10% per year encouraged authorities to regulate contain costs. The different LFSS were analysed to extract the regulatory measures. Since 2008 first cost containment regulation have been created to ensure appropriate use of LES. In 2010, an update of inscription criteria and radiation has been published, later updated in 2014, and 2016. We reviewed the impact on introduction of these regulations on the national budget control of LES. The LES drugs list represent on average 2% of Health Insurance expenses. First starting 2005, the total amount of expenses of “LES” has undergone very significant growth for +17.5% between 2005/2006, +11.9% between 2006/2007 and 5 drug removal, +15.3% between 2007/2008. Secondly since 2009, the total amount of expenses has seen a significant slowdown in growth, +4.3% between 2009/ 2010 and 5 drugs removal, -1% between 2010/2011, 0.4% between 2011/2012 and 12 drugs removal, +6% between 2012/2013 and 5 drug removal, +3% between 2013/2014 and 7 drugs removal, +5% between 2014/2015, and 9 drugs removal showing a better controlled evolution of the expenses. Finally since the last 2016 decree the rate was <1% between 2015/2016 and 6 drugs removal and 4 partial, +11% between 2016/2017 and 1 drug removal and <1% between 2017/2018. Ministry of Health introduced several economic regulation tools that contributed to control the LES budget thanks to removal allowing to free budget room for new products. Although budget control of LES is effective, impact on drug access remain to be better understood.