Pharmacists face compensation model changes

Pharmacists in France are experiencing significant changes to how they are paid, driven by economic pressures and the growing clinical responsibilities they are expected to take on. These changes aim to reflect the evolving role of pharmacists, which now includes tasks like patient orientation, blood pressure measurement, and tobacco cessation support.

Clinical tasks underpaid relative to their impact

Despite these clinical tasks contributing 46% of the growth in the reimbursable margin, they account for less than 1% of overall pharmacist compensation. Unions argue that the core of a pharmacist’s profession should remain medication dispensation but advocate for a new economic model that better balances compensation for prescription processing and reduces reliance on volume-based fees.

Dispensation fees remain a major revenue source

Dispensation fees, totaling 4.255 billion euros in 2025, represent a significant portion of pharmacy compensation. The box-based fee, the most lucrative component at 2.565 billion euros, is under scrutiny as deprescription trends increase, with the pharmacy network losing over 40 million boxes in 2025.

Deprescription trends challenge the current model

Doctors are increasingly incentivized to reduce prescription volumes, leading to a decline in dispensation fees. A single box of antibiotics not dispensed can result in losses of up to 5 euros in fees, according to Julien Chauvin, president of the studies and economic strategy commission of the Federation of Pharmaceutical Pharmacists' Unions of France (FSPF).

Proposals for a prescription-based fee system

Proposals to shift compensation toward prescription-based fees, which accounted for only 383 million euros in 2025, are being considered. However, this transition must be carefully managed to avoid leaving smaller or struggling pharmacies behind.

New fees to reflect clinical responsibilities

A complex fee, which represented 25 million euros in compensation in 2025, is being proposed for replacement with a fee tied to patients with long-term illnesses (ALD). This change would better reflect the meticulous work required for chronic condition management.

Discounts on generic drugs bring revenue but lack clarity

Discounts on generic and biosimilar drugs, which brought 1.1 billion euros to the pharmacy network in 2024, are essential to the economic balance of pharmacies. However, these discounts are not precisely measured by the Health Insurance Agency, and inspectors have called for greater transparency and a fairer sharing of savings.

Public Health Objectives-Based Reimbursements decline

Public Health Objectives-Based Reimbursements (Rosp), which have been declining since 2022, are also under review. The Rosp for "Digital and Access to Care" dropped significantly, while the Rosp for "Responsible Use of Health Products" increased, but unions criticize the complexity and lack of clarity in the system.

Reforms aim to stabilize the sector

Proposals for future reforms include negotiating an additional Rosp to encourage consultations and doubling the compensation for consultations during a limited period. A fixed amount, conditional on achieving certain indicators like organization and quality, has also been suggested to stabilize the economic reform and support struggling pharmacies.