Traitements

Nouvelles règles pour les médicaments de substitution

Les règles de délivrance des médicaments génériques ont changé ce 1er janvier, voici tout ce qu’il faut savoir

Depuis le 1er janvier 2020, les médicaments sont remboursés sur la base du prix de leur générique. En moyenne, les génériques coûtent environ 40 % moins cher. Certaines exceptions sont prévues, mais elles devront être justifiées sur l’ordonnance par un médecin.

Le remplacement d’un médicament original (princeps) par son générique par le pharmacien devient systématique. La mention « non substituable » ne peut plus être ajoutée par le médecin sur l’ordonnance, sauf pour trois motifs médicaux bien précis : prévus dans l’arrêté du 12 novembre 2019

Un moins bon remboursement pour ceux qui refusent le générique
Il est toujours possible de refuser ce remplacement, mais cela entraine désormais un remboursement dégradé. Il se fait désormais sur la base du prix du générique, en moyenne inférieur de 40% à celui du princeps. La différence de prix est à la charge du patient.

Les anti-rejets ne sont pas concernés par ces nouvelles règles
Pas de changement à craindre pour les anti-rejets. Ils continuent de faire partie des exceptions pour lesquelles la mention « non substituable » permet la délivrance du médicament original sans impact sur le remboursement. Cette exception est motivée par leur marge thérapeutique étroite.
Une liste des médicaments à marge thérapeutique étroite pour lesquels le princeps continue à être délivré et remboursé à son tarif a été établie(1).

Deux autres exceptions au remplacement du princeps par le générique sont prévues :
– Les médicaments génériques qui n’ont pas de forme pédiatrique et sont inadaptés pour un enfant. Par exemple un princeps disponible sous forme de sirop mais dont les génériques seraient uniquement sous forme de comprimé. A ce jour cette situation n’existe pas.
– Une contre-indication formelle et démontrée à un excipient présent dans tous les médicaments génériques disponibles, alors que le médicament de référence ne comporte pas cet excipient. Il s’agit d’une situation très rare qui ne concernera que très peu de médicaments.


(1) Il s’agit de : azathioprine, ciclosporine, évérolimus, mycophénolate mofétil et mycophénolate sodique (anti-rejets), lamotrigine, lévétiracétam, pregabaline, topiramate, valproate de sodium et zonisamide (antiépileptiques), lévothyroxine (hormone thyroïdienne), et buprénorphine (traitement substitutif aux opiacés).

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