FSPF approves government plan with reservations

The Federation of French Pharmaceutical Unions (FSPF) has approved the government's plan to address the financialization of pharmacies, though it has pointed out certain limitations. The government's plan, presented on October 13, aims to control the effects of financialization through three axes and ten measures: supporting professionals during their establishment, preserving their independence, and regulating investments, particularly in costly technical platforms.

Scale of financialization in healthcare

The figures illustrate the scale of the phenomenon: 4 billion euros have been invested by funds in health between 2020 and 2024, 62% of medical biology sampling sites are operated by six financial groups, and investment funds own approximately 30 to 35% of imaging centers. In pharmacies, one-third of the owners would have contracted a bond loan.

FSPF calls for stronger enforcement

The FSPF welcomes a preventive approach but regrets the absence of curative measures for already existing situations and the lack of clearly defined sanctions in case of violations. Fabrice Camaioni, president of the union, stated that "the professional orders will need to have the necessary means and obviously have the possibility to recover all contracts in order to control them."

Regulating financial groups through tax

Article 10 of the 2027 Social Security Financing Bill (PLFSS) provides for regulating groups, whose growing role and lack of transparency have been pointed out by the report of the Igas and IGF, published last May. A 15% tax on certain financial flows passing through laboratories could generate 120 million euros. The objective is to recover part of the value captured by groups, particularly around generics, and redirect it to pharmacies. The FSPF supports this approach, while emphasizing "that it is fundamental that it is indeed directed toward pharmacies."

Upcoming discussions with Senate

On October 29, the union will meet with the Senate along with the Union of Office Pharmacists' Unions (USPO) and the two unions representing the groups - the Chamber of Syndical Groups of Pharmacists Federgy and the Union of Office Pharmacists' Groups (UDGPO) - to discuss these provisions.

Controversy over antibiotic dispensation

Another subject of contention, Article 28 initially provided for the dispensation per unit (DAU) of certain antibiotics. The Social Affairs Committee of the National Assembly replaced it with an amendment expanding the device to medications whose packaging would be considered inadequate. For the FSPF, this extension would burden administrative work without demonstrated benefits. It prefers adapting packaging and respecting prescription recommendations. "It's a real false good idea," criticizes its president, who recalls that the Court of Auditors has also warned about the risk of increased costs and the absence of efficiency gains. The FSPF intends to contact the deputies before the amendment is examined in session.

Uncertain future for PLFSS bill

The outcome remains uncertain: the PLFSS could be adopted with amendments, via the use of article 49.3 or by decree. In the latter case, the original article 28 would be reinstated. The review clause at the heart of the discussions.

Preparations for remuneration reform

The first preparatory meeting for the reform of the remuneration model took place at the National Health Insurance Fund (Cnam). For the FSPF, it is impossible to build a new model without first verifying the financial trajectory provided for by the current agreement. The review clause of the first addendum to the pharmaceutical agreement has been opened during the summer of 2026 during a key meeting at the Ministry of Health on June 22, 2026 between the National Health Insurance and the USPO and FSPF unions. It has been agreed that if the financial trajectory provided for by the agreement and the amounts actually recorded or forecasted by the official network exceed 0.5%, parameters can be modified to make up for the delay. The conventional objective is to provide an additional billion euros to the network in 2027. However, according to the estimates of Iqvia presented by the union, the shortfall would reach 60 to 65 million euros in 2026 and could rise to 150 million in 2027. The Cnam contests these figures and must return with refined data.

Impact of generic price cuts

Fabrice Camaioni also points out the impact of the price reductions of generics: "a decrease of 180 to 200 million euros would result in a loss of remuneration of 40%, or about 80 million euros for pharmacists. We will have to really activate this review clause," he says. The FSPF is now waiting for the responses from the National Health Insurance in the coming days or weeks. Possible paths for evolving the model have been discussed, but the substantive discussions have not yet begun.

Rules for company vaccinations

Restrictive rules for vaccination in companies. Asked by a member about the sale of influenza vaccines to companies, Fabrice Camaioni recalls that a pharmacy cannot directly deliver lots of 10, 50, or 100 doses without a prescription. In addition, a company is not authorized to store vaccines. Two options are possible: a named prescription for each employee, issued by a doctor or nurse, or an order on prescription for professional use. The FSPF has issued a circular specifying the necessary mentions. The president of the union regrets "This extension of European regulation by listing the vaccine does not benefit us, as it is poorly adapted to the needs of pharmacies, but we will organize ourselves," says Fabrice Camaioni.