Liste en sus (additional list funded on top of hospital tariffs)

The liste en sus covers the medicinal products and medical devices reimbursed by the national health insurance system on top of the tariffs for hospital services of healthcare institutions. It departs from flat-rate funding by diagnosis-related groups, which normally includes the cost of products used during hospitalisation, so as not to hinder access to innovative and costly products. Inclusion is made by ministerial order, and the reimbursement tariff is set by the Economic Committee for Health Products.

Conditions for inclusion

Inclusion is reserved for medicinal products administered mainly during hospital stays, whose cost is high relative to the tariffs for stays and which bring sufficient therapeutic progress. Inclusion applies indication by indication.

Reimbursement tariff and hospital purchasing

The national health insurance system reimburses the institution on the basis of the reimbursement tariff. Where the institution purchases below that tariff, in particular following a competitive tender, the difference is shared between the institution and the health insurance system according to rules laid down by the legislation. Proper use of the products is governed by contracts concluded with the regional health agency and the health insurance system, and non-compliant use may lead to reduced reimbursement.

Removal and competition

Removal from the liste en sus brings the cost of the medicinal product back into the tariff for the stay, which profoundly changes its economics and purchasing conditions. It occurs in particular where less costly alternatives exist. The arrival of biosimilars or hospital generics, after patent expiry, results in tenders in which price becomes decisive. Advanced therapy medicinal products, often administered once at a very high cost, raise specific funding issues.

Key points

The liste en sus guarantees hospital funding for innovative and costly products. Eligibility should be checked indication by indication against the improvement in actual clinical benefit and the cost of treatment. As patent expiry approaches, anticipating the effects of possible removal and of hospital tenders is a central issue for commercial strategy.

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This glossary entry is general in scope and does not constitute legal advice.

Dhenne Avocats acts in pharmaceutical patent disputes and on the medicines regulatory questions that accompany them, from the marketing authorisation to the supplementary protection certificate.

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