REIMBURSEMENT BY THE HEALTH INSURANCE FUND OF A MEDICAL DEVICE PURCHASED IN ANOTHER MEMBER STATE OF THE EUROPEAN UNION
Cour de cassation, deuxième chambre civile, 6 juin 2024, pourvoi n° 21-25.527
In its ruling of 6 June 2024, the Cour de Cassation (French Supreme Court) ruled that French policyholders must obtain reimbursement for the purchase of a medical device bought in another EU Member State, under the same conditions as if the device had been bought in France (except for health reasons), provided that reimbursement is covered by French regulations.
In this case, a French couple purchased a pushchair and its accessories, adapted to their child’s disability, on the website of a distributor based in Spain. Their primary health insurance fund (CPAM) refused to reimburse them.
The couple decided to appeal to the court, which upheld their claim for reimbursement. The CPAM appealed to the Court of Cassation against the court’s ruling, on the grounds that reimbursement requires the production of a care sheet by a provider whose details are listed in the national register.
In its answer, the Cour de Cassation points out that under Articles 26, 34, 36 and 56 of the Treaty on the Functioning of the European Union, restrictions on imports and measures having equivalent effect are prohibited between Member States, subject to exceptions on public health grounds.
The Court added that in accordance with Article R. 160-2, III, of the Social Security Code (prior authorisation for reimbursement of healthcare provided within the EU) and Directive 2011/24/EU of 9 March 2011 on the application of patients’ rights in cross-border healthcare, medical devices, other than those requiring prior authorisation, which are purchased in another Member State of the European Union (or the European Economic Area) are not subject to prior authorisation and are reimbursed to insured persons under the same conditions as if they had been purchased in France, provided that the coverage of these devices is mentioned in French legislation.
Therefore, the Court of Cassation dismissed the appeal and ordered the CPAM to pay the sum of 3,000 euros to its policyholders.
