For medicines and pills, lo­tions and po­tions, not to men­tion ex­pert med­i­cal ad­vice, look no fur­ther than the phar­ma­cies of France, as Kate McNally ex­plains

Living France - - Contents -

Cover story This month, Kate McNally ex­plains why phar­ma­cies are an im­por­tant part of the health care sys­tem in France

ittle havens of beat­i­tude lie in wait be­hind the flash­ing green neon cross on the streets of France. Shelves are lined with more po­tions and lo­tions than you ever knew ex­isted, in del­i­cate, mostly white pack­ag­ing, mak­ing you feel health­ier just by look­ing at them. Kindly phar­ma­cists and their as­sis­tants (also in white) wait to lis­ten and ad­vise in a balmy calm that im­me­di­ately soothes all your senses.

Welcome to the world of the French phar­macy – a bou­tiquestyle chemist as far re­moved from the likes of Boots and Su­per­drug as foie gras is from Spam. But these oases in the desert of ill-health are un­der threat. The French gov­ern­ment has out­lined pro­pos­als al­low­ing the sale of non-pre­scrip­tion medicines, such as parac­eta­mol and cough mix­ture, in su­per­mar­kets. While this is ac­cepted prac­tice in the UK, French phar­ma­cies play a key role at the tail-end of the so­phis­ti­cated French health care sys­tem which, claim the phar­ma­cists, would be un­der­mined by open­ing up the sec­tor.

To un­der­stand this bet­ter, let’s take a closer look at their role.


There are more than 23,000 phar­ma­cies across France, even most ru­ral vil­lages have one. The net­work is made up of small in­de­pen­dent phar­ma­cies owned by qual­i­fied phar­ma­cists who will have stud­ied six to seven years to ob­tain their de­gree. They take the same foun­da­tion train­ing as trainee doc­tors and other health care clin­i­cians, and in the fi­nal year must write a the­sis on a spe­cial­ist sub­ject.

French phar­ma­cists be­lieve their role is as much to ad­vise and ed­u­cate their cus­tomers as it is to sup­ply medicines. They gen­er­ally have reg­u­lar con­tact with their cus­tomers, es­pe­cially in smaller towns and vil­lages, and in many cases are the first port of call for ad­vice on ail­ments, be­fore doc­tors, such is the level of trust and re­spect they com­mand. An im­por­tant part of their train­ing is cen­tred on what is called ‘ l’éd­u­ca­tion thérapeu­tique du pa­tient’ (pa­tient ther­a­peu­tic ed­u­ca­tion), which is all about ed­u­cat­ing peo­ple in terms of rais­ing aware­ness of health is­sues and dis­eases, en­sur­ing ap­pro­pri­ate use of medicines, and recog­nis­ing symp­toms and side ef­fects.

CESPHARM (the Comité d’Éd­u­ca­tion San­i­taire et So­ciale de la Phar­ma­cie Française) sup­ports them in this mis­sion, dis­sem­i­nat­ing in­for­ma­tion and or­gan­is­ing cam­paigns (for ex­am­ple, this sum­mer, how to stay well dur­ing a heat wave).


French phar­ma­cies, like a French per­son’s med­i­cal cab­i­net, are well stocked. What­ever the ache, pain or rash – ears, throat, feet, eyes, stom­ach – you name it, the phar­ma­cist will whisk a strange­named rem­edy out of the seem­ingly end­less be­hind-the­counter draw­ers. And there’s the rub. You will have to ask for the medicine, as French phar­ma­cists, be­ing the pro­fes­sion­als they are, like to in­ter­act with the cus­tomer and quite pos­si­bly ask a few ques­tions to make sure they are giv­ing you the very pre­cise treat­ment needed for your spe­cific prob­lem. Which means you will need to know a min­i­mum of French or learn some of the ba­sic brand names – for ex­am­ple Doliprane is parac­eta­mol, Advil is ibupro­fen, Bisep­tine is an­ti­sep­tic cream – and you will have to ask out loud for cer­tain prod­ucts that in the UK you pre­fer to grab swiftly and dis­creetly from the shelf for your­self!

This ap­proach also means that on oc­ca­sion you need to be a pa­tient with pa­tience. It is not un­com­mon for a fairly lengthy con­sul­ta­tion to take place, though there is of­ten an as­sis­tant to take care of the more straight­for­ward pur­chases who will come to the res­cue.


While medicines ac­count for around 80% to 90% of sales, French phar­ma­cies also sell a wide range of nat­u­ral health and beauty prod­ucts, usu­ally en­tic­ingly dis­played in the open free-serve space. These prod­ucts will al­ways have a ben­e­fi­cial health el­e­ment, such as or­ganic, nat­u­ral or ther­a­peu­tic in­gre­di­ents, or pro­tec­tive prop­er­ties. So while you will find lip balm and laven­der oils, you won’t find main­stream cos­met­ics or false nails. Equally, the phar­ma­cist will know the prod­ucts on sale and have ver­i­fied their nat­u­ral com­po­si­tion or ther­a­peu­tic ben­e­fit.

Most phar­ma­cies also stock a range of an­i­mal health care prod­ucts, in­clud­ing flea col­lars, vi­ta­mins and tic treat­ments, which are usu­ally slightly cheaper than they would be at a vet­eri­nary surgery.


Although the phar­ma­cist is usu­ally ca­pa­ble of ad­vis­ing which medicine you need, he or she may well sug­gest you go to the doc­tor in or­der to ob­tain a pre­scrip­tion. Most medicines are en­tirely or par­tially free with a pre­scrip­tion.

This pay­ment method works through what is called the carte vi­tale sys­tem – es­sen­tially a na­tional health card car­ry­ing your per­sonal de­tails, which is the gate­way to the French health care sys­tem. It is ar­guably the first ad­min­is­tra­tive piece of pa­per (or plas­tic) you should ap­ply for on mov­ing to France (ap­ply at the lo­cal CPAM – Caisse Pri­maire d’As­sur­ance Mal­adie – where you can find out what to do).

In the phar­macy, sim­ply hand over the pre­scrip­tion and your carte vi­tale, and quite likely you won’t have to pay a penny. You may also be asked on the first visit to a phar­macy for de­tails of your mutuelle – this is the top-up pri­vate in­sur­ance that most French peo­ple, and those liv­ing in France, take out to cover some, or all, of the re­main­ing per­cent­age to be paid for medicines and health care, or to pay for treat­ments that aren’t in­cluded in sub­sidised French health care. De­tails of your mutuelle

French phar­ma­cists be­lieve their role is as much to ad­vise and ed­u­cate their cus­tomers as it is to sup­ply medicines

are en­tered into the sys­tem and you won’t nor­mally be asked for them again on sub­se­quent vis­its. You will pay up front any costs not cov­ered by the state, and are re­im­bursed a few days later di­rectly into your bank ac­count by your mutuelle.


Medicines are strongly sub­sidised by the French wel­fare state, which some be­lieve leads to an over-readi­ness on both the part of pa­tients to ask for them, and doc­tors to pre­scribe them. Phar­ma­cists see their role at the end of the line as one of con­trol­ling sup­ply and keep­ing a check on pa­tients’ use of medicines – as men­tioned above, their re­la­tion­ship role of­ten means they are bet­ter placed to spot de­vel­op­ing pat­terns or prob­lem­atic side ef­fects.

The French state sets the price of pre­scrip­tion medicines, and at the start of 2015 raised the pay­ment made to phar­ma­cists per box of medicine from €0.53 to €0.80, ris­ing to €1 from 2016. In re­turn, phar­ma­cies have agreed to aim to in­crease the sale of generic prod­ucts, as op­posed to branded prod­ucts, to 85%, and to lower the mar­gins they take on spe­cific medicines sold (these fol­low a slid­ing scale down­wards ac­cord­ing to the price of the

Be­fore leav­ing the UK, ap­ply for the S1 form which cov­ers your health costs in France on a tem­po­rary ba­sis

prod­uct). They have also un­der­taken to add in­struc­tions rel­e­vant to in­di­vid­ual pa­tients on how to ad­min­is­ter the medicines or drugs, should pa­tients have con­cerns.

With the French gov­ern­ment aim­ing to re­duce the health care bud­get, which will in­evitably have a knock-on squeeze on med­i­cal sup­plies, the FSPF (Fédéra­tion des Syn­di­cats Phar­ma­ceu­tiques de France) were happy to re­duce mar­gins – which are greater for more ex­pen­sive medicines likely to be more widely hit by cuts – for the guar­an­tee of a higher set pay­ment on all med­i­cal prod­ucts.

When it comes to pric­ing non-med­i­cal prod­ucts, phar­ma­cies are free to set their own mar­gins and there­fore have more con­trol over po­ten­tial rev­enues from this sales plat­form. A care­ful se­lec­tion of the right cos­metic and health prod­ucts to suit a phar­macy’s pri­mary cus­tomer pro­file can sig­nif­i­cantly boost prof­its. It no doubt helps to ex­plain why these prod­ucts are dis­played in a man­ner that makes the sight and smell of them so dif­fi­cult to re­sist!

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