France : Impact of some drugs prescribed “Hors T2A” on DRG tariffs…

This is a surprising decision that has just been taken by the French Ministry of Health.

In fact, the Ministry of Health has issued a circular related to the implementation of the "savings plan for hospitals", a plan which aims at generating 730 millions of euros of savings for 2015 (the final objective being to save € 3 bn during the 2015-2017 period).

In this circular there is an annex specifically dedicated to savings that could be made with some drugs prescribed "Hors T2A" (or "on the exclusion list" or "paid on top of DRGs"). Just as reminder : when a drug is registered on the "Hors T2A" list, that implies that its cost will not be included in the global DRG cost corresponding to the situation in which the drug is used and that the drug will be 100% reimbursed.

According to the MoH, the annual increase (around +7% in 2013, almost the same in 2014) of the budget dedicated to "Hors T2A" drugs is not linked to the launch of new innovative (i.e. ASMR 1 to 3) and expensive drugs (which are usually the drugs concerned by the "Hors T2A" list). It is mainly linked to drugs registered on the "Hors T2A" list (as they are considered as innovative in specific indications) which obtained, in a second time, an extension of their indications. Most of the times, in these extended indications these drugs represent only a minor or no clinical improvement compared to drugs already included in the DRG tariffs (and thus, less expensive in regard of public health expenditures as they are not to be reimbursed "on top of the DRGs" tariff).

The MoH considers that around 500 millions of euros are spent each year for these "non-innovative" (i.e. ASMR 4 or 5 in the extended indications) but, nevertheless, paid "on top of the DRGs" drugs.

That is the reason why, in the specific case of chemotherapies administered at the hospital, the MoH has decided that hospitals will be paid 40 euros less than the usual tariff of the corresponding DRGs (around 300 euros) when a "hors T2A" drug will be used (and when drugs with a similar efficacy and with a cost included in the DRG tariff will already be available).

For the moment, the measure is only focused on these DRGs (tumoral or non-tumoral chemotherapy) as they concentrate around two third of the "Hors T2A" drug-related expenditures.
Will that decision apply to other therapeutic areas and corresponding DRGs in the near future ? To be followed...