She sues social security to obtain reimbursement for her treatment

THE ESSENTIAL

• A breast cancer patient sues health insurance to obtain full coverage of her treatment.
• His doctor prescribed the “original” drug because generics cause serious side effects.
• The CPAM only reimburses it up to the price of generics. This represents 2,200 euros per year at its expense.

In addition to battling breast cancer for over ten years, Christiane is now facing the Health Insurance (CPAM) which refuses to cover part of her treatment. The patient who confided her story to the Parisian, takes the matter to court.

Breast cancer: an out-of-pocket cost of 2,200 euros per year

The fifty-year-old, who has undergone multiple operations, treatments and chemotherapy since her breast cancer diagnosis in 2001, began a new protocol in March 2023 that included a generic. However, she quickly developed serious side effects. “Kidney failure, a lot of fatigue. You don’t play with people’s lives like that.” her husband said to RMC.

Her oncologist then prescribed the original drug, which is only reimbursed up to the price of generics. This leaves the patient with 180 euros per month to pay. Although she received a temporary two-month reimbursement in 2023, she has been paying the difference since then, since her mutual insurance company also refused to reimburse the remaining cost.

This represents 2,200 euros per year for the couple. A significant cost that forces Christiane to continue working despite her health concerns. “It’s a double punishment for us on the financial side and the aspect of respect for the person”her husband told RMC. “I feel an injustice and a double fight: a fight against cancer and a fight against the CPAM”continued Christiane.

The CPAM assures that it follows economic rules

When questioned about this case, the CPAM defended itself by indicating that it was following the regulations. “Since the loss of its patent, many generics exist with significant price differences. In 2023, the Economic Committee for Health Products set a reimbursement rate that applies to both patients and Health Insurance. The laboratory manufacturing Faslodex has not adjusted its price accordingly.”.

Unable to make herself heard, Christiane decided to take the matter to court: “I want to be reimbursed and above all for my fight to help other patients who do not have the means to receive proper treatment and do not dare to say anything”she explained to the Parisian.