Several reforms directly affecting the daily lives of patients and caregivers came into effect in September 2026. Capped sick leave, penalties for refusing biosimilars, and an increase in out-of-pocket expenses expected in October: this week’s health news paints a picture where reimbursement rules are changing rapidly, and the financial consequences for insured individuals need to be assessed.
Sick leave, biosimilars, and out-of-pocket expenses: overview of changes as of September 1, 2026
| Measure | Before September 2026 | Since September 1, 2026 | Source |
|---|---|---|---|
| Initial prescription duration of a sick leave | No uniform regulatory cap | Capped at 31 days | Decree No. 2026-498 of June 12, 2026 |
| Renewal of a sick leave | Duration left to the physician’s discretion | Capped at 62 days per renewal | Ma Santé News, August 31, 2026 |
| Refusal of a biosimilar or hybrid at the pharmacy | Third-party payment maintained | Advance payment possible, third-party payment suspended | TF1 Info, August 31, 2026 |
| Out-of-pocket expenses (expanded reform) | Current terms in effect | Modification of reimbursements expected in October 2026 | RFI, August 21, 2026 |
This table summarizes the main measures. Each targets a different audience: employees on leave, patients undergoing biological treatment, and insured individuals covered by supplementary insurance. The following paragraphs detail what concretely changes for each situation. Following health news on santeauquotidiencom allows you to spot these developments as soon as they are published in the Official Journal.
Capping sick leave: what Decree No. 2026-498 changes in practice
The decree of June 12, 2026, effective since September 1, introduces two distinct caps. The initial prescription of a sick leave can no longer exceed 31 days. Each renewal is limited to 62 days.
This measure targets city medicine. General practitioners, who issue the vast majority of sick leaves, must now calibrate the duration from the first consultation. A longer leave requires a formal renewal, with a new clinical evaluation.
Consequences for patients on long-term leave
For chronic conditions or serious post-operative follow-ups, the capping does not reduce the total possible duration of a leave. It imposes a mandatory visit to the doctor every two months at most. The patient who does not renew on time risks an interruption of compensation.
Leaves related to long-term illnesses (ALD) remain subject to this framework. The difference lies in the follow-up: where some leaves could be extended by phone or mail, the decree makes physical or teleconsultation more frequent.
Refusal of biosimilar at the pharmacy: a direct cost for the insured
Since September 1, 2026, a patient who refuses the biosimilar or hybrid offered by their pharmacist faces the loss of third-party payment. In practical terms, the insured must pay all costs upfront before being reimbursed by Health Insurance.
A biosimilar is a nearly identical copy of a biological drug whose patent has expired. Its efficacy and safety are validated by the European Medicines Agency. The price is lower than that of the reference drug, which explains the authorities’ desire to generalize their substitution.
What this changes in pharmacies
- The pharmacist offers the available biosimilar. If the patient accepts, nothing changes in the reimbursement process.
- If the patient refuses without a medical reason noted on the prescription, the third-party payment is suspended for this dispensing. The insured pays, then requests reimbursement from their fund.
- Prescriptions marked “non-substitutable” for medical reasons remain protected: third-party payment applies normally.
This measure mainly concerns expensive biological treatments (anti-TNF, insulins, growth hormones). For these molecules, the price difference between the original and the biosimilar can represent several hundred euros per year.
Increase in out-of-pocket expenses expected in October 2026: which areas are affected
Several decrees published in the Official Journal foresee a modification of reimbursement terms starting in October 2026. The targeted areas cover medications, medical devices, and non-emergency transport.
The details of the reform, relayed by RFI on August 21, 2026, and by Marketscreener on August 24, indicate that certain protected groups will retain their current level of coverage. Beneficiaries of complementary health insurance (C2S) and patients in ALD should not see their out-of-pocket expenses increase in the affected areas.
What distinguishes this reform from usual adjustments
The peculiarity lies in the transfer of part of the financial burden to complementary health insurance. Mutuals and insurers will have to absorb a larger fraction of the cost, which could be reflected in contributions as early as 2027.
- Medications with moderate medical service rendered may see their reimbursement rate by Health Insurance decrease.
- Non-emergency medical transport is among the areas where patient out-of-pocket expenses may increase.
- Medical devices (prosthetics, orthotics, respiratory equipment) are also mentioned in the regulatory texts.
For insured individuals without complementary coverage, the increase in out-of-pocket expenses will be direct. For those covered by a mutual, the impact will depend on the ability of their contract to compensate for the disengagement of Health Insurance.
Updated list of reimbursable specialties: ANSM decision of September 2, 2026
The ANSM updated on September 2, 2026, the list of specialties approved for communities and reimbursable. Among the additions are antibiotics, antifungals, and an anticancer drug. This update, published on the agency’s official website, broadens access to treatments previously not covered in the community or in certain establishments.
The addition of antibiotics to the list comes amid regular tensions on the stocks of certain molecules. The inclusion of an anticancer drug opens the possibility of hospital coverage without going through a temporary authorization for use.
The coming weeks will clarify whether other specialties will join the list during the next updates. The pace of these decisions has accelerated since the beginning of the year, with several publications in the Official Journal within a few days in early September.
