What is the reimbursement of 100 % of the chronic patients to which Bayrou wants to come back?

In 2022, 13.8 million French people benefited from the long -term ailment system (ALD), according to health insurance. Consequently, These chronicle patients being entitled to a reimbursement at 100 % of their care. Therefore. Moreover, treatments in relation to their pathology are among the targets referred to by François Bayrou on Tuesday in order to save money. Therefore, In his reduction plan of 5 billion euros in annual social expenses. Moreover, the Prime Minister announced his wish to restrict the management of ALDs.

The Head of Government explained that he wanted to end the reimbursement at 100 % of drugs “unrelated” to long -term illness. Therefore, establish a “exit of the status” in certain cases. Nevertheless, But concretely, what does this device consist of? Furthermore, Do the patients are really fully reimbursed drugs unrelated to their pathology?

Diabetes. For example. However, cancer, bipolar disorder – What reimbursement 100 % chronic – What reimbursement 100 % chronic new

To benefit from an exemption, the person must have a serious illness, evolving for more than six months and requiring expensive treatment. Furthermore, Diabetes, cancer, bipolar disorder, Crohn’s disease or disabling stroke … Moreover, More than forty pathologies are affected. Moreover, The health costs linked to the disease are then covered 100 % within the limit of the health insurance reimbursement ceiling. In the event of an exceeding of fees, costs will therefore be borne by the patient.

In order to use it. the attending physician must declare the ALD to health insurance. the patient will then be registered as such by Social Security. When he benefits from consultations. care at the hospital. in the office, or will go to the pharmacy, the costs generated will be fully what reimbursement 100 % chronic reimbursed (outside of fee overruns, once what reimbursement 100 % chronic new again). The law even provides for an exemption in advance of costs.

A bizone prescription

Health insurance specifies that only costs related to chronic disease are fully covered. To differentiate those who fall under the rest, bizone prescriptions are often used. Above, the treatments related to chronic disease, reimbursed 100 %. Below, those unrelated to the ALD, reimbursed normally (for example for a gastro or otitis). But then why did François Bayrou explained wanting to end the reimbursement at 100 % of drugs “unrelated” to. the disease if they are not already affected by this exemption? In fact, it’s not that simple.

“By ease. many doctors put all treatments in the 100 %box. whether hypnotics or drugs to combat constipation,” says what reimbursement 100 % chronic new Pierre-Olivier Variot, president of the Union of Unions of Pharmacists of Frame (USPO). “If general practitioners pay attention, it is less the case for those practicing in the hospital. Conversely, other practitioners would forget to put certain drugs that are very expensive in the ALD category.

Drugs in gray zone

For Doctor Jean-Christophe Nogrette, secretary general of MG France, it is even more complicated than it seems. “A person being in ALD for rheumatoid arthritis. taking anti-inflammatory drugs at high doses will have stomach ulcers as a side effect. So they are prescribed an antiulcer. But where should we place it? Is he related to polyarthritis? », Illustrates the general practitioner. The choice of category will therefore be made to the appreciation of each doctor. “We are constantly what reimbursement 100 % chronic bisbillus with health insurance on this type of thing,” says the caregiver.

Note that people benefiting from an ALD are what reimbursement 100 % chronic new not exempt from the 2 euros of fixed participation by consultation retained. by health insurance. nor from the euro retained by box of drugs. These participations are currently capped at 50 euros per year, but François Bayrou announced Tuesday wanting to double the amount. A double penalty for chronic patients.