Discounts on Reimbursable Medicinal Products in France: A Dialogue Under Pressure
Prices, margins and discounts on reimbursable medicinal products in France are strictly regulated, in particular to control public health expenditures. The rules governing these discounts are laid down in the Social Security Code (“CSS”), mainly in Article L.138-9, and have recently been amended by the Social Security Financing Act for 2025 (Law No. 2025-199 of February 28, 2025, “LFSS 2025”, art. 33).
Article L.138-9 CSS specifically regulates the maximum level of discounts, rebates, and equivalent commercial or financial advantages, including service remunerations under Article L.441-3 of the Commercial Code, that suppliers can grant to pharmacies on reimbursable medicinal products (hereinafter the “Discounts”).
For most reimbursable reference medicinal products, the total value of Discounts granted by any supplier to any pharmacy may not exceed 2.5% of the ex-factory price excluding taxes (PFHT) per product line, per pharmacy, per calendar year. However, there are exceptions, such as reference products subject to a single reimbursement rate, known as the Tarif Forfaitaire de Responsabilité (TFR).
The LFSS 2025 has introduced a significant modification to Article L.138-9 CSS, namely the extension of the higher discount cap – previously applicable to generics – to substitutable biosimilars and hybrid medicinal products, as well as to reference pharmaceutical products with identical public sale prices. Under the new rules, for these categories of products, the maximum Discounts that suppliers may grant to pharmacies can now be set by Ministerial Order up to a ceiling of 50% of the PFHT, aligning them with the regime already in place for generics.
The forthcoming Ministerial Order setting the maximum Discounts cap for these products is highly expected and should be subject to discussions with the Health Ministry soon. The Government faces pressure to use this Order as a tool to contain public health expenditure, particularly by limiting or reducing the high Discounts cap of 40% historically granted to pharmacies on generics.
This situation creates tension among pharmacies, as many rely on these Discounts as a significant source of income. Some assert that any reduction in the allowable Discounts cap on generics could threaten the financial stability of smaller or independent pharmacies.
These tensions seem to have been exacerbated by a recent Ministerial Order setting certain Discounts caps published on May 14, 2025. This Order – which only applies to generics and not hybrids and biosimilars – maintains the Discounts cap at 40% of the PFHT, but only until next July 1st. This suggests that the Health Ministry wants to strictly regulate the timetable for future consultations or discussions on Discounts.
Like pharmacies, their suppliers must organize themselves and prepare for these discussions, which could prove heated in the early days of summer…
