After a first wave of reforms in 2015 that limited the reimbursement of ophthalmic products in France to once every other year, instead of once a year, which sent the national optical market down (see other article in this issue), a new set of far-reaching regulatory changes is scheduled to be implemented from January 2020. President Emmanuel Macron announced earlier this month a raft of new measures in line with a promise made in his presidential campaign that some basic health needs, including optical glasses as well as hearing aids and some dental treatments, would become costless as part of France's public social security system.

It had been estimated that about 10 percent of French people have been skipping some types of healthcare, including eyesight correction, because of its cost. The French Health Ministry pointed out that the median price of a pair of glasses with simple corrective lenses amounted to €290, with a “Reste à Charge” of €65, i.e. €65 left for the consumer to pay from his or her own pocket after refunds from social security and mutual insurance funds. The aim of the new plan, dubbed 100% Santé (100% Health), is to come with a “Reste à Charge” of zero euros, at least for the 95 percent of French people who have a private insurance scheme on top of the national social security system.

After six months of tense negotiations between French healthcare authorities and industry representatives, the agreement was formally signed on June 13 with the approval of the Rassemblement des Opticiens de France (ROF), an association that reportedly represents 83 percent of French opticians, including all the main retail banners in the sector. The details of the new reimbursement scheme were officially published by the French Healthcare Ministry yesterday, with an open option for stakeholders in the industry to make observations in writing within one month. 

If the new regulations are finally approved, which seems likely, customers will in effect be given two choices, either purchase fully refunded frames or lenses or products that may be partly refunded by the mutual insurance funds. The new rules define two types of products: Class A products that will come at zero cost to the consumer after social security and private insurance refunds, and Class B products - or so-called “free market” items - where the government will only refund a symbolic five cents of a euro.

For Class A glasses with single-vision lenses, the maximum fully refunded levels will go from €95 if they have simple lenses up to €265 if they have the most complex lenses. For glasses with progressive lenses, the refunds will be limited at between €180 and €370. Eligible Class A lenses will include products supplied with special options like thin lenses and anti-scratch and anti-reflective coatings. However, some special products like unbreakable lenses, corrective sun lenses and photochromic lenses are not included in the Class A category. The latter only are estimated to represent 10 percent of the market.

Lens producers will have to present their catalogs to a committee of the French Healthcare Ministry for eligibility of their products in the Class A category, with no flexibility in the type of material used for a specific level of correction. Officials of GIFO, the French association of eyewear manufacturers, pointed out that this could come to the detriment of the quality of the lens, for example with the thickness of the lens taking priority over its optical performance. It will be interesting to see how the suppliers will adapt their offer to these new constraints as the current average prices of the products actually sold in the market - €154 to €197 for a pair of simple single-vision lenses and €398 to €490 for progressive lenses - are much higher than the governmental price range.

The above-mentioned Class A packages include a maximum of €30 for the frame itself. Opticians will have to propose at least 17 adult and 10 children frames in two colors with this maximum price tag for a full refund. Consumers will still have some flexibility in the choice of the products, for example by selecting their lenses in the Class A category, with full reimbursement, while choosing a frame in the Class B category, for a possible refund of the latter by their mutual insurance fund only. However, the new rules will cap the insurance's refund for the frame to a maximum of €100, against €150 today.

On the retail side, market observers feel that the changes may accelerate the reduction in the number of opticians operating in the country. With about 12,500 stores, France remains the European country with the highest density of opticians, but for the first time in 2017, that number went significantly down with a negative balance of 232 doors (see other article in this issue) and that trend is forecast to pick up speed in the next years. Independent opticians are seen as taking the strongest blow since the leading retail banners have already developed costless offers for their customers, partly through private label ranges.

On the manufacturing side, representatives of GIFO told Les Echos, the French business daily, that the production of high-end lenses in France will necessarily be penalized, with the Class A lenses made in Asian factories. They also feel that the maximum amounts for refunds on frames will boost Asian imports to the detriment of the remaining French eyewear manufacturers, which are reportedly employing an estimated 3,500 people. Their industry association had been part of the round-table discussions with the government officials but the actual signing of the agreements was limited to the representatives of the opticians.

Market experts feel that the actual impact of the new reform will lie in the hands of French consumers – in which proportion are they going to buy into the Class A product category? – and of the private mutual insurance funds – how will they adapt their offer in the so-called free market?

The new governmental program also includes initiatives that will reinforce the healthcare mission of opticians. For example, consumers will be able to go directly to opticians for an eyesight check and the adaptation of their lenses if they have an ophtalmologist's prescription not older than five years. Opticians will be able to charge €10 for this service separately, which will be fully refunded. This measure is also set to address huge bottlenecks in certain regions where consumers have to wait sometimes up to one year for an appointment with an eye doctor. In view of this, eye care students will be required to spend three years in school instead of only two as is now the case to become certified opticians, shifting their status to a level closer to that of the certified optometrists in other countries.