An interview with Michael Bismuth, Event director of GEMME (Generic Same Medicine)

 

Agnes Jacobs - We are currently in the midst of reviewing the Social Security Financing Bill (PLFSS) for 2026. Could you explain the general philosophy behind the measures you are advocating?

Michael Bismuth- The philosophy behind our proposals is based on a clear principle: prioritizing regulation that focuses on increasing the volume of less expensive drugs with the same efficacy, rather than regulation centered on reducing their value. Generic and biosimilar drugs are central to this approach: they enable the social security system to save more than 2.5 billion euros each year. It is therefore inconsistent to undermine products that contribute so significantly to the sustainability of our system.

Today, financial regulations disproportionately penalize generic drugs, biosimilars, and low-cost mature products, even though they form the foundation of the system’s efficiency. Our sector is subject to the safeguard clause, a levy originally designed for high-cost, high-growth drugs. Its extension to generics in 2019 has had a devastating effect: it pushed the sector’s profitability into the red in 2023 and threatens the availability of hundreds of essential medicines, increasing the risk of supply shortages and, consequently, public health risks.

The more we expand our operations—and thus the savings for Social Security—the higher the tax burden becomes, which is a major economic contradiction. The 2026 Social Security Financing Bill will exacerbate this situation by introducing an additional levy on gross revenue before tax, thereby creating double taxation. In a sector characterized by low prices and margins, these levels of taxation are unsustainable.

Our philosophy is based on three principles:

Ensuring the economic viability of companies producing generic drugs, biosimilars, and value-added medications: without them, there would be no alternatives and no cost savings. Social security cannot be preserved by undermining the very players that make it viable.

Do not penalize the increase in volume: the more these less expensive products with the same therapeutic efficacy are used, the more the community

saves money. However, the safeguard clause reverses this logic by imposing higher taxes on those who generate the most savings.

Enable a volume-based cost-saving policy: to ensure that the government can continue to rely on generic and biosimilar drugs, these products must remain commercially viable.

The exemption from the safeguard clause is therefore not a sector-specific benefit, but a prerequisite for continuing to generate savings and treat 28 million patients with reliable, accessible, and locally available products.

In short, the goal is to move away from a system that undermines the availability of affordable medicines and return to a coherent regulatory framework: ensuring the development of products that generate sustainable cost savings. It is also essential not to pit manufacturers against pharmacists: together, we generate cost savings, ensure access to care, and contribute, on a daily basis, to a local network that serves patients. The challenge, therefore, is to protect the stakeholders who safeguard social security by excluding substitutable and mature products from the safeguard clause in order to ensure their viability and preserve the sustainability of the French model.

 

Agnes Jacobs - Currently, most pharmacists’ concerns center on the profitability of their pharmacies and the sustainability of the pharmacy network. Given that pharmacists remain the healthcare professionals closest to patients, what steps should be taken to ensure the network’s sustainability and preserve access to care?

Michael Bismuth -Pharmacists have legitimate concerns: the profitability of community pharmacies is declining, and in some areas, there is a risk that the last remaining local healthcare provider will disappear.

To maintain the regional network, action must be taken on several fronts.

It is very important to strengthen the role of the pharmacy in the healthcare continuum, particularly as it takes on new responsibilities such as vaccinations, diagnostic testing, and pharmaceutical consultations.

Furthermore, rural or struggling pharmacies cannot be saved without targeted support. Assistance programs do exist, but they need to be expanded, and innovative solutions—such as satellite pharmacy locations or mobile pharmacies—must be developed for the most remote areas.

The third point concerns the integration of the pharmacy into the healthcare system: pharmacists must be fully integrated into the patient care pathway, working in collaboration with physicians, hospitals, and Regional Health Professional Communities (CPTS) through digital tools such as the Shared Medical Record (DMP). An integrated pharmacy is not just an asset—it is becoming indispensable.

Another major challenge is that of attractiveness: to encourage young pharmacists to set up practices, particularly in underserved areas, we need an appealing practice model, appropriate training, financial support, and recognition of their clinical role and their connection with the community.

Finally, the economic aspect remains central: a sustainable pharmacy must anticipate and adjust its decisions regarding margins, operating costs, and diversification. It is also necessary to recognize the value of professional services (prevention, therapeutic monitoring, and patient care) in order to ensure the pharmacy’s long-term viability and reduce regional disparities in access to care.

By combining several complementary measures—strengthening the role of pharmacies, providing targeted support to the most vulnerable pharmacies, improving integration into the healthcare continuum, making the profession more attractive, revaluing services, and implementing appropriate economic management—it becomes possible to sustainably secure the pharmacy network across the entire country and guarantee access to care for the entire population.

 

Agnes Jacobs - One of the panel discussions on the political agenda at PharmagoraPlus in 2026 is titled “After Generics: How Can We Successfully Implement Biosimilar Substitution in Community Pharmacies?” - Could you give us an overview of GEMME’s perspective on this topic?

Michael Bismuth- For GEMME, the challenge is clear: the development of biosimilars depends on increasing volumes, not on reducing their value. If we truly want to accelerate their adoption in France, the solution lies not in further lowering prices, but in increasing their use.

These are safe medications—with no loss of benefit for patients, based on more than a decade of clinical data—that are effective and interchangeable with the reference biologics. Yet France continues to lag behind, with a market penetration rate of 35% in 2024, far below the 80% observed in several European countries, such as Italy.

This delay represents a significant loss of revenue: biosimilars could generate more than 300 million euros in savings as early as 2026/2027, given that their price is already about 40% lower than that of the reference drug.

In this context, putting further pressure on prices would be counterproductive: prices in France are already, on average, 44% lower than in neighboring countries (€212 versus €317), which undermines the industrial ecosystem and, in the long run, the supply chain.

A balance must be struck between supporting the market and encouraging substitution. Pharmacies play a decisive role in this process, building on 20 years of generic substitution. But this transition requires continuing the work already underway: continuing to support patients, strengthening logistics, securing reimbursement, and fostering open communication with prescribers.

Our approach is based on three key areas.

The first step is to establish a simple regulatory framework that provides genuine incentives. Certain measures already exist in the initial provisions of the 2026 Social Security Financing Bill, which we view very positively, such as the direct billing system for biosimilars: without a medical justification, patients who refuse a biosimilar are not eligible for direct billing. Substitution should also be introduced as early as possible, given that it does not result in any loss of opportunity for patients. This should be done while accelerating its rollout and raising patient awareness of the cost.

The 2026 Social Security Financing Bill thus incorporates a proposal put forward by GEMME: starting two years after a biosimilar is brought to market, the reference biologic would be reimbursed only at the price of the biosimilar when it is chosen without medical justification.

Beyond these measures, we believe it is possible to go further to encourage the use of the most cost-effective treatments. For example, health insurance could allocate each physician a prescription budget that incentivizes the use of the least expensive treatments. In the event of a significant overspend, the CNAM could conduct an audit and request justification for any prescription of non-substitutable products.

The second focus area aims to increase acceptance of biosimilars among patients and prescribers: reassuring them, explaining the benefits, sharing scientific data, and highlighting the individual and societal benefits.

The third priority is to maintain a sustainable economic model. We must stop undermining the companies that produce the least expensive drugs and exempt biosimilars from the taxes that penalize them, because taxing these products amounts to penalizing the very drugs that help control spending. The savings generated must be transparent and reinvested in access to treatment, prevention, and support for pharmacies.

In short, biosimilars represent a major opportunity for France, but this opportunity will only be realized by increasing sales volumes. Community pharmacies play a key role in making biosimilar substitution a win-win solution for patients, pharmacists, and the healthcare system as a whole.

 

Agnes Jacobs - Finally, in your opinion, why should pharmacists attend PharmagoraPlus 2026?

Michael Bismuth- PharmagoraPlus is the only time of year when a pharmacist can, in just two days, get a head start on all the topics that will shape their practice: mental health, burnout prevention, artificial intelligence in the pharmacy, regulatory compliance, economic and environmental performance, high-cost medications, shortages, underserved areas, and biosimilar substitution. It’s the place where people come to

Understand, reflect, and leave better equipped for the future A true distillation of collective intelligence, led by leading experts, that enables pharmacists to be better informed and better prepared for changes in their profession.

It is also the only time of year when pharmacists can freely exchange ideas with one another in an informal and supportive setting and naturally expand their professional network. The trade show brings together the entire pharmaceutical industry: a unique opportunity to meet, all in one place, key players in the pharmaceutical sector, suppliers, and publishers. Here, you can ask questions, get immediate answers, test tools, negotiate, and compare solutions—a level of efficiency that is hard to achieve in the daily hustle of a pharmacy.

In other words, PharmagoraPlus is about looking ahead to the pharmacy of tomorrow, anticipating the changes in the profession to better support patients and strengthen the resilience of the healthcare system. In just two days, you save precious time and leave with new contacts, concrete solutions, and a breath of fresh air for your career. That’s the power of a place where the profession comes together to exchange ideas and build its future.

 

A member of the PharmagoraPlus steering committee, Michael Bismuth is Event director of GEMME (Générique Même Médicament), a professional organization representing the generic, biosimilar, and value-added drug industry. He contributes to the implementation of GEMME’s advocacy strategy, bridging the gap between health policy and industry issues. He also shares his expertise as a lecturer at Paris-Saclay University and CY Cergy Paris University, within the Master’s program in “Communication Policy, Influence, and Public Affairs,” and co-founded the “Public Affairs and Advocacy ” (DAPP) at Sciences Po Saint-Germain-en-Laye, a continuing education program designed for professionals wishing to specialize in advocacy.