Governing (through) Prices Determining the Price of Reimbursed Pharmaceuticals in France
This article examines how prices for pharmaceuticals reimbursed by the state in France have been determined from the beginning of the system after World War II to the mid- 2010s. We analyze the successive forms of this policy, from unilateral state administration of prices, in effect from 1948 to the 1980s, to price negotiation in the framework of agreements between an interdepartmental committee and pharmaceutical companies, starting in the mid-1990s. We contend that state-imposed price controls bring together two types of market government: government of values, where the aim is to assess drugs according to principles of social justice (promoting public health, complying with national health insurance budget requirements, developing industrial employment) and government of conducts, where the aim is to assess pharmaceuticals in connection with the concern of market effectiveness (ensuring that the prices determined will orient industrial and market actors in the direction of the general interest). The “fair price” is hardly self-evident, and the work of determining it in these conditions gives rise to confrontations within the committee and in its negotiations with the pharmaceutical companies, between actors with plural and antagonistic conceptions, those of social justice and market effectiveness.