France will from 1 October end the exemption from patient cost-sharing for medicines rated as providing low medical benefit by the French National Authority for Health (Haute Autorité de santé, HAS) when they are prescribed for a long-term condition (affection de longue durée, ALD). The ordinary 15% reimbursement rate will instead apply.
Decree No. 2026-285 of 16 April established the change. Previously, treatments related to an eligible ALD were exempt from the ticket modérateur, allowing medicines that would ordinarily receive 15% statutory reimbursement because of a low service médical rendu (SMR) to be covered at 100%.
For patients, compulsory health-insurance coverage therefore falls from 100% to 15% of the reimbursement basis for these medicines. The remaining 85% may be covered partly or fully by complementary insurance, but patients without such cover face a direct increase in out-of-pocket costs. National Health Insurance (Assurance Maladie) has advised pharmacists to alert affected patients and refer them to their doctor where continuity of treatment becomes difficult. Other eligible ALD care remains fully covered.
A 2024 IGAS-IGF spending review estimated that applying ordinary cost-sharing to low-SMR medicines in ALD could save compulsory health insurance around €90 million, before allowing for switching to other treatments. The measure therefore shifts part of expenditure towards complementary insurers and patients.
Reimbursement listing and price remain unchanged, but the low-SMR classification now has a more direct effect on use in ALD populations. Removing automatic 100% coverage increases the patient's exposure to the cost of treatment and may strengthen incentives to switch to alternatives with higher reimbursement. Products used extensively in ALD could therefore see changes in prescribing and volume even though their formal reimbursement status is unchanged.
Source: National Health Insurance
Link: Médicaments à SMR faible prescrits pour une ALD : fin d’exonération du ticket modérateur (Medicines with low medical benefit prescribed for an ALD: end of exemption from patient cost-sharing)
Date: 30 September 2026
Source: Official Journal of the French Republic
Link: Décret n° 2026-285 du 16 avril 2026 relatif à la participation des assurés aux frais afférents aux médicaments à service médical rendu faible (Decree No. 2026-285 of 16 April 2026 on patient contributions for medicines with low medical benefit)
Date: 17 April 2026
Source: General Inspectorate of Social Affairs and General Inspectorate of Finance
Link: Revue de dépenses relative aux affections de longue durée : Pour un dispositif plus efficient et équitable(Spending review on long-term conditions: towards a more efficient and equitable system)
Date: 12 September 2024
