It was an opinion that caused quite a stir. In June 2019, at the request of the Minister of Health at the time, Agnès Buzyn, the High Authority for Health (HAS) delivered its conclusions on homeopathy. These products have no “not scientifically demonstrated sufficient efficacy to justify reimbursement”estimated the experts, leading to the delisting, from January 2021, of small white granules.
A new episode in the turbulent history of this contested therapeutic practice. In 1985, Georgina Dufoix, then Minister of Health, granted reimbursement for homeopathic treatments up to 65%. A global exception – only Switzerland and Germany (temporarily) were to follow in France’s footsteps. The defenders of delisting have therefore continued to point out that this therapy has never proven to be more effective than the placebo effect. In 2003, Minister Jean-François Mattei cut the pear in half and divided the rate by the same amount, which remains a subject of controversy. After the opinion of the HAS in 2019, the reimbursement increases to 15% on January 1, 2020 before disappearing the following year. The stated goal is savings for health insurance, which would have reimbursed 128.5 million euros for homeopathic medicines in 2017.
A “collapse of sales”
Did this decision sign the death warrant for homeopathy, as the sector feared? President of the Federation of Pharmaceutical Unions of France (FSPF), Philippe Besset evokes “the collapse of sales of reimbursable homeopathic products” and provides figures compiled by IQVIA, a company specializing in medical data. In 2019, before the start of delisting, 126 million tubes (containing granules) and doses (containing globules, to be taken at one time) were sold. Since then, the curve has declined: 110 million in 2020, 59 million in 2021 and 43 million in 2022.
Among these sales, it is the reimbursable or formerly reimbursable units that are experiencing the greatest collapse, falling from 88 million units in 2019 to 8 million in 2022. While the delisting obviously plays its part, the erosion the use of homeopathy is prior and continuous: in 2016, 155 million units were sold; three years later, before any drop in support, it was already only 126 million.
Price increase
The abolition of reimbursement by health insurance resulted in another major change: a sharp increase in tariffs. In question, the passage of the VAT from 2.1 to 10%, but also the liberalization of the price, which leaves full latitude to laboratories and pharmacies to increase it to compensate for the expected losses. “The tube of homeopathic granules has gone from an average of €2.45 to €3.80, a considerable increase”, notes Pierre-Olivier Variot, president of the Union of Community Pharmacists (USPO).
A hard blow for the portfolio of patients accustomed to homeopathy. “85% of them continue to use it as therapy despite the delisting, supports Charles Bentz, the president of HoméoFrance and the National Union of French Homeopathic Physicians (SNMHF), based on the results of a survey published in June 2021. But for 15% of patients, the cost of homeopathic medicines is now prohibitive. » A proportion, however, insufficient to justify the slump in sales.
The rest of the explanation is in fact to be sought from the side of the therapists themselves: 56% of homeopathic physicians questioned by the SNMHF declare that they have changed their prescription habits in order to limit the financial impact for their patients. “We have replaced one-time doses with tubes of granules that can be used for two or three months, which cuts the cost by four or more,” says Antoine Demonceaux, homeopathic general practitioner and coordinator of the interuniversity diploma in homeopathic therapy. IQVIA figures show that the doses formerly reimbursed are those with the most impressive decrease in sales, falling from 32 million in 2019 to 2 million in 2022.
Fewer practitioners
It is difficult to assess the evolution of the number of doctors who prescribe these products, declaring themselves homeopaths (which is not recognized as a specialty) or not, but it is in all likelihood decreasing. When the reimbursement was announced, the Council of the Order of Physicians had ceased to recognize homeopathy diplomas issued by private schools and requested the establishment “validated university training of the IUD type, training that respects the rules of medical ethics, training that has no link of interest with the pharmaceutical industry”. This has been done since October 2022, with a very marked decrease in the number of doctors among those registered (pharmacists, midwives, etc.), as recognized by Antoine Demonceaux, who partially attributes it to medical demographic decline.
However, the image of homeopathy, criticized since almost its beginnings for its inefficiency, does not seem to have suffered from the delisting. According to a survey conducted by Ifop last September, 83% of French people say they are in favor of its use. “The end of treatment may have created doubts in the minds of people who are not convinced, but it has changed absolutely nothing for patients who are used to it and know its benefits”, believes Charles Bentz. “There is no loss of confidence, adds Antoine Demonceaux. Many new patients consult us, particularly in paediatrics, for chronic ENT problems and anxiety disorders, our spearheads. After the electroshock of delisting, it is up to us to define the most relevant field of action for homeopathy within the health system of tomorrow. » Homeopathy has not said its last word.
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Homeopathy or the principle of similarity
Invented by Saxon physician Samuel Hahnemann in 1796, homeopathy proposes to “treat with the same”: a small dose of “poison” could have a therapeutic effect on a pathology with similar symptoms.
In 1932, the Boiron brothers created the Central Homeopathic Laboratory of France, which would become Laboratoires Boiron in 1967.
The best-selling homeopathic products today are theArnica montana (for various traumas), Oscillococcinum (flu-like conditions) and Camilia (baby teething).