Posted on Tuesday, June 30, 2015

Article L 315-2 of the Social Security Code provides that the receipt of certain benefits may be subject to the prior agreement of the medical control service according to the terms defined by decision of the college of directors of the National Union of Health Insurance Funds.

Two decisions of theUNCAM dated June 24, 2014 (JO of September 23, 2014) made the payment of certain cholesterol-lowering drugs subject to the favorable opinion of the medical control service.

As of November 1, 2014, the prior agreement procedure applies the following three cholesterol-lowering drugs:

  • rosuvastatin (CRESTOR ®),
  • ezetemibe alone (EZETROL ®)
  • and ezetemibe in fixed combination with simvastatin (INEGY ®).

This formality is compulsory for any initiation of treatment as soon as the patient has not been dispensed with the drug during the last six months.

A decision tree specific to each molecule contains specific recommendations. It is in fact a question of favoring more efficient treatments while guaranteeing the patient the same quality and effectiveness of treatment.