There is usually a contract between the state and the company providing the drug. An example there : http://www.fiercepharma.com/story/france-strikes-big-hep-c

There is usually a contract between the state and the company providing the drug. An example there : http://www.fiercepharma.com/story/france-strikes-big-hep-c-treatment-deal-gileads-sovaldi/2014-11-20 http://www.fiercepharma.com/story/france-strikes-big-hep-c-t... The thing is that is the state refuse to reimburse the drug it won't likely be prescribed/used, so the company has an incentive to sell at an acceptable price. You can also read some of : https://en.wikipedia.org/wiki/Bevacizumab#Society_and_culture https://en.wikipedia.org/wiki/Bevacizumab#Society_and_cultur... to see how new drugs are approved or not, taking into account their cost and effectiveness.