Why are some medication not reimbursed in France and what you can do about it

The French state healthcare system operates on a reimbursement model and when it comes to prescriptions, you pay the pharmacist upfront for the medication and then a percentage of the cost is reimbursed to you, via your carte vitale.

But sometimes you present a prescription and are told ce médicament n’est pas remboursé par la sécurité sociale (this medication is not reimbursed by social security). 

This doesn’t mean that you can’t have the medication – but it means that you will have to pay the cost out of pocket, and won’t be getting reimbursed.

By flagging this up, the pharmacist is trying to help you to avoid unexpected costs. They may also offer another version on the same medication – which is, reimbursed. But more on that later. 

READ MORE: How to get a carte vitale in France and why you need one

So why does this happen?

France’s healthcare system distinguishes between whether a medicine is authorised for sale and whether it is approved for reimbursement by the national health insurance system (Assurance Maladie).

To qualify for reimbursement, three conditions generally have to be met:

• the medicine must appear on the official list of reimbursable medicines;
• it must be prescribed by an authorised healthcare professional;
• it must be prescribed within the approved therapeutic indications for which reimbursement has been granted.

If any of these conditions are not met, you may have to pay the full cost yourself.

Why are some medicines not reimbursed?

The most common reason is that the medicine has not been judged to provide enough clinical benefit compared with existing treatments.

Before a medicine can be reimbursed, France’s independent health authority, the Haute Autorité de Santé (HAS), evaluates its Service Médical Rendu (SMR) – its actual medical benefit – and, where relevant, the improvement it offers over existing therapies.

For this reason new drugs may not be reimbursed, as they are still going through the HAS evaluation process.

The HAS makes recommendations, but the final reimbursement decision rests with the Ministry of Health. 

Sometimes medicines are removed from reimbursement (déremboursés) because newer and more effective treatments have become available, evidence shows only limited medical benefit, or public health authorities decide that healthcare funding should be prioritised elsewhere. For example, homoeopathy medicine is no longer reimbursed since 2021. 

According to the Assurance Maladie, as new, and often expensive, therapies enter the market, public resources must be prioritised, which sometimes means older medicines are no longer reimbursed.

Take Ozempic – often associated with weight loss medication. It is not reimbursed by the Social Security system when prescribed for obesity alone. The medicine is only reimbursed for certain patients with type 2 diabetes, under strict prescribing conditions.

Instead, France began reimbursing the obesity medicines Wegovy (semaglutide) and Mounjaro (tirzepatide) from June 2026. 

READ MORE: France to expand access to weight-loss drugs for obesity patients

Reimbursement rates vary

Even when a medicine is reimbursable, you are not always reimbursed in full. There are four reimbursement rates for medicines:

• 100 percent for medication recognised as irreplaceable and expensive;
• 65 percent for medication offering significant medical benefit;
• 30 percent for medication offering moderate medical benefit and certain compounded preparations;
• 15 percent for medication offering low medical benefit. 

Any remaining costs may be covered by your complementary health insurance (mutuelle), depending on their policy.

READ ALSO: Health insurance: How to choose a ‘mutuelle’ in France

In what cases can you obtain full reimbursement?

Patients with certain serious or chronic illnesses may qualify for the Affection de Longue Durée (ALD) status, France’s long-term illness program. 

If approved for an ALD exonérante, treatments related to that condition are reimbursed at 100 percent of the Social Security reimbursement rate (although not necessarily the full retail price if extra fees apply). The treating doctor must complete a treatment protocol, which is then approved by the patient’s health insurance fund.

Other people qualifying for higher levels of reimbursement regardless of the usual reimbursement rate include pregnant women from the start of the sixth month of pregnancy until 12 days after giving birth, and people receiving treatment for a recognised work accident or occupational disease. People covered by the Complémentaire santé solidaire (CSS) or the Aide médicale de l’État (AME) can also have their eligible medicines covered in full, subject to the rules of those schemes.

What if your medicine isn’t reimbursed?

You have a few options if a medicine is not included on the reimbursable medication list:

• ask your doctor whether an equivalent reimbursable medicine is available, check whether a generic, hybrid or biosimilar version is reimbursed;
• ask whether the medicine is being prescribed outside its reimbursed indications;
• if you have a long-term condition, check if you qualify for ALD status;
• check whether your mutuelle offers additional reimbursement for non-covered medicines. If you happen to go to the pharmacy and realise that your medicine or treatment is not reimbursed, the pharmacist will give you a form which you can send to your mutuelle to ask if they cover it. 

You cannot apply directly to the HAS for an individual reimbursement decision. The HAS evaluates medicines at population level and advises the government – it does not deal with reimbursement requests.

Individual questions about reimbursement should instead be directed to your local CPAM (health insurance fund).

Refusing generics can also affect reimbursement

Another thing to be aware of is that refusing a substitute medicine could cost you more.

In many cases, pharmacists can replace a brand-name medicine with a generic, or, from September 1st, 2026, with certain hybrid or biosimilar medicines. If you refuse the substitute without your doctor marking the prescription as “non-substitutable” (not substitutable) for a valid medical reason, you may have to pay the full cost upfront.

Your reimbursement will then be based on the cheaper substitute, meaning you could end up paying more out of your own pocket.

In France, generic (médicaments génériques), hybrid (médicaments hybrides), and biosimilar (médicaments biosimilaires) medicines are all intended to provide therapeutic alternatives to an existing reference medicine, but they differ in their composition and regulatory requirements.

Useful French vocab to know

Remboursement – reimbursement 

Ordonnance – prescription 

Tiers payant – Third-party payment (you don’t pay upfront)

Reste à charge – The amount the patient has to pay out of pocket after reimbursement

Non substituable – “Not substitutable” (written on a prescription when a pharmacist cannot replace a medicine with a generic or other approved substitute)

Feuille de soins – a treatment claim form used to request reimbursement