On 6 October, representatives from pharmacists' unions met with the National Health Insurance Fund (Cnam) to discuss three key projects: supporting diabetic patients, implementing the orientation system in the healthcare system (OSyS), and cardiovascular prevention. While the cardiovascular prevention project is progressing, it faces some uncertainties. The Cnam is considering both detecting arterial hypertension in non-diagnosed patients and monitoring blood pressure in those already diagnosed. However, the latter depends on guidelines from the High Authority for Health (HAS), which are expected by the end of the year. Once these guidelines are available, they must be translated into a practical framework, and the specific roles pharmacists can play must be defined. This process could delay the implementation of blood pressure monitoring until the first or second quarter of 2027. However, not all parts of the cardiovascular prevention project will be affected equally, as some aspects may progress more quickly than others. The diabetes support project is further along. Much of the content has already been developed, and a response from the HAS is expected by mid-October. If no major changes are made, the focus will then shift to implementation. Pharmacists' unions are primarily calling for simplification of the framework. Pierre-Olivier Variot, president of the Union of Pharmacists' Unions (USPO), says the current structure of interviews is too complex and wants more consistency. The same logic applies to remuneration: the goal is to align the payment terms with those of other pharmaceutical services. However, no specific amounts have yet been negotiated. The OSyS framework has been a major topic of discussion. Its widespread implementation requires a sustainable economic model. The Cnam is considering several options: payment per act, a flat rate, or tiered remuneration. The Federation of French Pharmaceutical Unions (FSPF) and USPO oppose the tiered approach, arguing that it would hinder the development of OSyS. Fabrice Camaioni, president of the FSPF, warns that this method is similar to the one used in teleconsultation, which he believes has had negative effects. The president of the USPO agrees, stating, "We perform an act, we are paid." The Cnam, however, is struggling with an unknown factor: estimating the volume of work. It is difficult to predict how many consultations will be requested once the framework is fully implemented, and thus, the cost is unclear. Fabrice Camaioni estimates that around 10 million patients per year may seek consultations for conjunctivitis, compared to 400,000 for burns, but he acknowledges these figures are not precise. The Cnam has also proposed a flat rate for pharmacies involved in multiple missions, such as vaccination, colorectal cancer screening, blood pressure measurement, and OSyS-related activities. The FSPF supports this idea, provided the flat rate is added to the payment for individual acts. At this stage, however, the overall framework remains unclear. According to the USPO, the discussions have also touched on a possible "vaccine management" role for other healthcare professionals, but the exact responsibilities—such as ordering, storage, delivery, and returns—are still unknown. Pierre-Olivier Variot summarizes this uncertainty by saying, "We don't know." The FSPF and USPO have also stressed the importance of receiving the Cnam's working documents in advance. They want to prepare their proposals before negotiations and be ready to test the Health Insurance's data with their own analyses when financial discussions begin. Fabrice Camaioni notes that time is limited and that they cannot afford to lose time discovering figures at the last minute. "The deadlines are short. We will not systematically lose half an hour discovering the numbers on the table," he says.