France’s National Health Insurance Fund (Caisse nationale de l’Assurance Maladie, CNAM) has placed medicines among the main sources of savings proposed for the 2027 social-security budget, combining continued price regulation with stronger action on prescribing and treatment use.
CNAM presented its annual Charges et Produits pour 2027 (Expenditure and income for 2027) report on 2 July. The report identifies €3.9 billion of potential health-system savings against a projected 2026 health-insurance deficit of €13.8 billion. Around €1.3 billion of the proposed savings relate to healthcare products, with medicines accounting for most of this amount.
Oncology receives particular scrutiny. Net expenditure on cancer medicines reached €7.1 billion in 2024 – around one-quarter of medicine spending – after average annual growth of 10.2% over five years. CNAM reports that 80% of oncology treatments reaching the market over that period received an ASMR V rating, indicating no demonstrated improvement in medical benefit over existing options.
The payer proposes greater use of therapeutic de-escalation, including shorter treatment duration or reduced intensity where evidence shows that outcomes can be maintained. It also wants treatment choices to favour the most efficient options and to reflect the needs of older cancer patients more closely.
The approach extends beyond oncology. CNAM proposes stronger support for deprescribing in community and hospital care, including multidisciplinary medication reviews and a dedicated review when patients enter residential care. It reports potentially inappropriate medicine use in 60% of residents aged 75 or over in residential care and 42% of hospitalised patients.
The emphasis represents an evolution from CNAM’s 2026 proposals, which explicitly called for substantial price reductions for medicines rated ASMR IV or V. CNAM Director General Thomas Fatôme subsequently told the National Assembly that this recommendation had not been repeated for 2027, although ASMR V products would remain within the €1.3 billion product-savings programme through both prescribing measures and scrutiny of price coherence.
France Assos Santé and the Ligue contre le cancer have argued that the oncology proposals remain too cautious, calling for stronger evidence on survival and quality of life and more systematic use of real-world outcomes. The debate nevertheless places medicine value, treatment duration and prescribing appropriateness alongside conventional price reductions as likely themes in preparation of the 2027 Social Security Financing Bill.
Source: National Health Insurance Fund
Link: Présentation du rapport « Charges et Produits pour 2027 » (Presentation of the Expenditure and income report for 2027)
Date: 2 July 2026
