Medical imaging: contrast products now provided by the radiologist

Not all organs and vessels are easily visible on traditional radiology imaging exams. For better visualization of possible lesions, radiologists can then use an intravenous injection of a contrast product (PDC): iodine derivatives for scanners and gadolinium for MRIs. Whatever they are, these contrast products were until now delivered to patients in pharmacies on medical prescription. However, following the adoption of a Social Security financing bill, they will no longer have to worry about purchasing these products on their own. From March 1, 2024, PDCs will be provided directly to radiologists. Although this new measure should bring relief to patients, professionals remain mixed, mainly for budgetary and organizational reasons.

Obviously, this change will simplify the patient's care pathway by avoiding having to go through the pharmacy. “To have a tooth pulled, dentists do not ask patients to buy the necessary anesthetics themselves. It's the same thing for contrast products: these are products for professional use. It is therefore not logical that it is up to the patient to obtain it,” says Dr Jean-Philippe Masson, president of the National Federation of Radiologists (FNMR). If the measure takes effect on March 1, radiologists will however be able to continue to prescribe them for a one-month trial period.

For the rest, this new organization will mainly have a financial impact. In a July 2022 report aimed at limiting the misuse of PDCs, the National Health Insurance Fund (CNAM) emphasized that this change will “limit the waste of products purchased by patients, but not used”. Ordering and inventory management errors: until now, it was estimated that the loss of PDCs delivered in France amounted to 30% for iodine derivatives and up to 15% for gadolinium. For good reason, these products provided to patients were single-use. From now on, radiologists will be able to purchase them in large quantities for several people. “France was still one of the only EU member countries not to use this so-called multi-patient packaging, which is nevertheless easier to manage and less expensive because all doses will be used. Before, single-use products were thrown away after the shelf-life date had passed,” underlines Dr Jean-Philippe Masson.

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However, the measure is far from unanimous among health professionals. Financially, the cost of contrast products represents a penalty of around 200 million euros for radiologists. For their part, the two main pharmacists' unions, the FSPF (Federation of Pharmaceutical Unions of France) and the USPO (Union of Community Pharmacists' Unions) also fear collateral damage. “This new organization will cause the pharmaceutical network to lose 25 million,” says Philippe Besset, pharmacist and president of the FSPF. This is why we are currently in discussions with the public authorities in order to find a solution to minimize this budgetary impact while improving the care pathway.

However, fears are also focused on the potential impacts for the patient. “In return for pseudo financial losses suffered by professionals, this measure is likely to lead to excess fees by radiologists not covered by social security, which creates a new problem and a greater disparity in access care", warns Pierre-Olivier Variot, president of the USPO.