The increasing distrust of generic drugs.

The rating of generics is declining among the general public. While they were still 62% in 2011 to systematically accept the substitution of a brand-name drug, the French are now only 57% to say they are ready to take it this year, according to the Fops poll published on Monday for the group of PHR pharmacists. They are also more reserved about the effectiveness of generics, 72% deeming it similar to that of brand-name drugs, against 77% in 2011.

As for the perception of the safety of generics fell by 10 points, with 61% of French people declaring themselves convinced that these drugs are "as safe" as original drugs, against 71% in 2011. Invited to give their opinion on the figaro.fr site last February, Internet users had been 48.78% to place their trust in generics.

The people questioned are also critical of the law of 2006, which abolished the third party payment in the event of a refusal of the replacement of originator drugs by generics by the pharmacist. For 46% of them, this measure infringes on their freedom. People aged 35 to 49 are even in the majority (51%) to question this measure, strictly applied since July 1, 2012.

However, the economy represented by generics continues to gain consensus, with 82% of French people believing that these drugs are more economical than original drugs. The substitution rate is currently 76%, which is still considered insufficient by the authorities.

Social Security now reimburses some 700 million boxes of generics per year, almost twice as many as in 2006, which has made it possible to save 1.3 billion euros per year.

Lucien Barnatan, president of the PHR group (which represents 11% of pharmacies in France), recognizes that "there is still some way to go" and that health professionals "will have to increase patient awareness." To restore the confidence of the French, he recommends replacing the law on third-party payment "by educational action, relayed through a national information campaign and which would be supported by pharmacists."

The loss of the third-party payment in the event of a refusal of a generic does not result from a law (nor, consequently, from a decree) but from an amendment to the agreement which binds pharmacists and Health Insurance. This amendment obliges them to sell at least 60% of generics (more in certain regions) under penalty of being converted, but their customers, them, can only be encouraged to accept them. If they refuse a generic, they will have to pay the price of the drug prescribed by their doctor, then fill out and mail the document themselves for reimbursement; two inconveniences that are generally sufficient to dissuade them from exercising their right to purchase the original drug. But nothing legally forbids them to do so: the generic does not.

The TPCG rule does not apply in three cases. The pharmacist does not have the right to refuse the third-party payment for an originator (original medicine) whose name is preceded on the prescription by the handwritten mention "NS" (not substitutable). Nor for those at the TFR price (originator sold at the same price, or even cheaper, than its generics). Nor for molecules that have been the subject of a recommendation or a warning from the National Medicines Safety Agency: Buprenorphine, Levothyroxine, anti-epileptics, and mycophenolate. If your pharmacist refuses you the benefit of one of these three exceptions, and even if your social security fund confirms its statements (it has been seen!), Both are in violation. The instructions that we have just recalled have an official character and a national scope;

The customer must pay for the drug for which he refuses the generic, and he will be reimbursed for it later, thanks to the paper invoice that the pharmacist is obliged to give him. But he retains the benefit of third-party payment for all the rest of the prescription, which the same pharmacist will have to transmit electronically to Medicare. For this trader, the workload is, therefore, double. But that does not authorize him to pretend to ignore an instruction which, again, applies throughout the territory in a uniform and obligatory manner.

All this information has been confirmed by the Health Insurance Department, which undertakes to remind its local funds and regional branches if necessary.