Understanding ”Service Medical Rendu” in the French Healthcare System

The Service Médical Rendu (SMR), or Medical Service Rendered, is a fundamental concept in the French healthcare system, particularly in the context of pharmaceuticals. It is a measure used to evaluate the therapeutic benefit of a medication, which plays a pivotal role in determining its reimbursement by the National Health Insurance (NHI).

What is SMR?

SMR is an assessment of the medical value of a drug. It considers several factors:

  • Efficacy of the medication: How effective is the drug in treating the condition it’s prescribed for?
  • Safety profile: What are the risks associated with using the drug?
  • Place in therapeutic strategy: How does the drug fit into the broader treatment landscape for the condition?
  • Public health impact: What is the overall benefit to the population’s health?

This assessment is conducted by the French National Authority for Health (Haute Autorité de Santé, HAS), which is an independent public body in charge of evaluating health products.

Levels of SMR

The SMR is classified into several levels, reflecting the degree of benefit provided by the medication:

  1. Major (majeur): This indicates a significant therapeutic benefit, often for medications that treat serious conditions or fill an unmet medical need.
  2. Important (important): This level is assigned to drugs that offer substantial therapeutic benefits but may not be as crucial as those with a ‘major’ rating.
  3. Moderate (modéré): This indicates a moderate therapeutic benefit, possibly because there are other effective treatments available.
  4. Low (faible): This level suggests minimal therapeutic benefit. Drugs with a ‘low’ SMR may still be used in certain scenarios but are not prioritized for reimbursement.
  5. Insufficient (insuffisant): This suggests that the drug offers no significant therapeutic benefit relative to other available treatments. Medications with this rating are typically not reimbursed.

Review and Reassessment of SMR

The SMR of a drug is not static and can be reviewed periodically. The frequency of review can vary based on several factors:

  • New clinical data or evidence: If new studies or clinical trials provide fresh insights into a drug’s efficacy or safety, the SMR can be reassessed.
  • Changes in the therapeutic landscape: If new treatments become available, or if the understanding of a disease changes, this can prompt a reevaluation of a drug’s SMR.
  • Safety concerns or issues: If new safety concerns arise, such as side effects or interactions with other drugs, the SMR might be reviewed.

The reevaluation process is also initiated by HAS and follows a procedure similar to the initial assessment. It involves a thorough analysis of the available data and a reassessment of the drug’s place in the treatment of the condition.


Understanding SMR is crucial for pharmaceutical companies operating in France, as it directly impacts a drug’s reimbursement status and, consequently, its market potential. Staying abreast of changes in drug evaluations and maintaining an ongoing dialogue with regulatory bodies is essential for navigating the French healthcare landscape effectively.

At Elliogen, we provide comprehensive support and strategic insights to help you understand and effectively manage the SMR process and other critical aspects of the French pharmaceutical landscape.

Contact us today to learn how we can assist you in maximizing your product’s potential in France.