Has Sanofi-Aventis Lost its Friends in Government?

Sanofi-Aventis may have fallen out of bed with the French government.

When Sanofi-Synthelabo gobbled up its larger peer Aventis in 2004 after a prolonged struggle, it was widely believed that Sanofi's president Jean-Francois Dehecq had received a little help from his friends in high places (read: the French president Jacques Chirac). The government wanted a large, national pharmaceutical flagship just as much as Dehecq wanted to crown his M&A record with his biggest acquisition to date.

They don't seem that friendly any more, though.

Far from embracing its national champion's new fat-buster drug with open arms, the French reimbursement authorities today gave it a distinctly lukewarm approval.

Acomplia (rimonabant, approved in the EU in June 2006 but reimbursed so far only in a handful of countries, including Sweden and Denmark) is relegated to the lowest tier reimbursement--35%--which corresponds to treatments of 'minor therapeutic value'. What's more, only obese patients with diabetes will be eligible for the 35% reimbursement (and even then, docs have to fill out the prescription on a special form--an "ordonnance d'exception"). The overweight lot with risk factors, though included on the label, will have to stump up the full €70 per month if they want the drug.

Yet it's not as if France can any longer claim to be a nation of slimmies, even though in the past their red-wine and foie-gras lifestyle was known as the "French paradox" because it didn't make them fat. These days, 1.2 million French people eat in McDonalds each day, and childhood obesity is growing at 17% annually. At this rate, reports the Roubaix journal in Northern France, the French could be as fat as Americans by 2020.

Still, despite initiatives such as National Weighing Day for French children on January 7, and significant political involvement (the Socialists in particular are jumping on the healthy eating bandwagon to try to muster support ahead of May's elections), the French government doesn't see Acomplia as a big part of the answer to bulging waistlines. Nor, incidentally, do the Germans: they refused point blank to reimburse Acomplia at all, dismissing it as a life-style drug.

Is there a trend here?

Either way, the pressure's on the Acomplia reps to get friendly with docs and persuade them to prescribe the drug anyway--but only for, er, patients with that particular combination of cardio-metabolic risk factors (that docs all know about and have time to measure).

Sanofi executives have always claimed that "this isn't an obesity drug". The authorities appear to agree.