The Directorate for Research, Studies, Evaluation and Statistics (Direction de la recherche, des études, de l’évaluation et des statistiques, DREES) has published a study on therapeutic innovation and price regulation in reimbursed medicines between 2016 and 2024, giving an official account of the growth in medicine spending before and after rebates.
The study draws on exhaustive reimbursement data from the National Health Data System (Système national des données de santé, SNDS), covering reimbursed medicines dispensed in community pharmacy and used in hospital. It also uses detailed rebate data paid by companies to National Health Insurance (Assurance Maladie, AM). This allows DREES to follow the difference between expenditure measured at reimbursed prices and expenditure after the confidential rebates that increasingly shape the French market.
The study follows several recent reports on the same expenditure challenge. The General Inspectorate of Social Affairs (Inspection générale des affaires sociales, IGAS) and the General Inspectorate of Finance (Inspection générale des finances, IGF) published Bilan et évolution du dispositif de régulation du prix des médicaments (Assessment and development of the medicine price-regulation system) on 7 May 2026, focusing on price regulation, rebates and the safeguard clause. IGAS and IGF then published Revue de dépenses sur les prescriptions en ville et à l’hôpital(Spending review on prescribing in community and hospital care) on 11 June 2026, covering prescribing expenditure across community and hospital care. LEEM’s Perspectives du marché pharmaceutique français sur les prochaines décennies (Perspectives for the French pharmaceutical market over the coming decades), published on 11 May 2026, considered future market growth from demography, chronic disease and therapeutic innovation.
DREES adds an official retrospective account of where expenditure growth has come from. Before rebates, reimbursed medicine expenditure increased by €12.1 billion (41.7%) between 2016 and 2024, reaching €41.1 billion. Most of the increase came after 2020, when gross spending rose by €11.4 billion (38.4%).
Rebates absorbed much of that growth. DREES reports that rebates rose from €1.2 billion in 2016 to €9.0 billion in 2024, an increase of €7.8 billion (650%). After deduction of product rebates and early-access rebates, net expenditure reached €32.0 billion in 2024. The net increase over 2016-2024 was €4.3 billion (15.5%).
The growth is concentrated in hospital-originated medicines. Net spending on high-cost medicines used in hospital increased by €1.8 billion (61%). Net spending on medicines prescribed in hospital but dispensed in community pharmacy increased by €4.1 billion (61%). Community prescribing fell by €0.9 billion (-6%).
DREES identifies antineoplastic and immunomodulating medicines as the main therapeutic driver. Their share of total spending increased from 24% to 34%. Pembrolizumab and daratumumab together accounted for nearly 20% of gross spending in that class before rebates.
The study gives a firmer empirical base to the current French pricing debate. Confidential rebates have limited the increase in net spending while preserving higher public prices for international reference pricing. The remaining pressure comes from a changing medicine mix, especially oncology and immunomodulation, leaving France’s expenditure challenge dependent on both price negotiation and the assessed efficiency of new treatments in relation to survival and quality-of-life gains.
Source: Directorate for Research, Studies, Evaluation and Statistics, DREES
Link: Innovation thérapeutique et régulation des prix : les déterminants de la hausse des dépenses de médicaments en France (2016-2024) (Therapeutic innovation and price regulation: determinants of the increase in medicine expenditure in France, 2016-2024)
Date: 1 July 2026
