A Tale of Two Pharmacies: France vs. Big Pharma USA

On my first ever trip to France, I was particularly alarmed by the abundance of green crosses posted at every street corner. As a California native, the green cross symbolizes one thing, and one thing only: marijuana. Growing up in Venice Beach, Los Angeles, where cannabis culture is especially prominent, the green cross was an unmistakable symbol for stores selling weed. So, when I arrived in France and spotted all these “dispensaries,” my curiosity about the French weed scene got the best of me, and I decided to walk into one. You can probably imagine my shock when I discovered that these establishments were not dispensaries, but rather French pharmacies.

This cultural misunderstanding prompted me to reflect on how differently France and the United States approach medicine, health, and the businesses behind them. In France, the pharmacies symbolize regulated, affordable care, while in the US, they often signify a market driven by profit. But which system truly serves people better?

In the US, picking up a prescription is not an easy or enjoyable task. As my fellow Americans can attest, even something as insignificant as acne cream can involve waiting in line for hours, dealing with unwelcoming staff and overworked pharmacists, and paying prices that feel illegal. I often found myself asking: how can I be paying $80 for a small tube of Tretinoin?

My frustration is a consequence of how “Big Pharma” – the chains of powerful and profit-seeking pharmaceutical companies – control how Americans obtain their medications. Drug companies, which drive major pharmaceutical corporations, face minimal government regulation and hold monopoly power over their products through patent protection. This allows them to set prescription drug prices at exorbitant rates, forcing many Americans to pay out of pocket. In 2024 alone, Americans spent $98 billion out of pocket, demonstrating the growing financial burden Big Pharma places on patients and families.

Beyond the rising drug prices on the consumer end, pharmacies themselves struggle to stay afloat. CVS, one of the most prominent US pharmacy chains, has closed 900 stores since 2022 and plans to close another 270 in 2025. Incidentally, my frustrating Tretinoin experience occurred at CVS, making the chain’s recent troubles feel personal and highlighting a deeper issue: the US pharmacy model is unsustainable.

An underlying cause for this instability is how pharmacies are paid for the prescriptions they fill. Most patients use insurance to cover the costs of their prescriptions, and insurers employ Pharmacy Benefit Managers (PBMs), third-party administrators that determine how much pharmacies are reimbursed, giving them tremendous leverage. Recently, reimbursement rates have become so negligible that many pharmacies lose more than they gain on prescription drugs. While PBMs are middlemen who partially contribute to the system’s lack of durability, it is ultimately the drug manufacturing giants at the top of the food chain who set the prices. Together, they have created a vicious circle where patients pay more, pharmacists earn less, and transparency is almost nonexistent.

Compared to my stress-inducing US prescription experiences, picking up my first prescription in France pleasantly surprised me. Unfortunately, this situation befell me when I had the inescapable “Freshers’ Flu,” and I was prescribed various medications to pick up. As I entered Pharmacie Saint Maurice across from Sciences Po, the pharmacist kindly greeted me, thoroughly explained how each prescription is used, and wished me a speedy recovery – all with a genuine smile and a sincere concern for my well-being. For three prescriptions, I left the pharmacy just €15 lighter and feeling truly cared for.

French pharmacies are regulated quite differently compared to those in the US. Notably, there are no pharmaceutical “chains” nor complicated insurance middlemen. Under the fifth section of the French Code de la Santé Publique, only pharmacists can own pharmacies, and each is limited to one location. This operation ensures that pharmacists independently run and are personally responsible for the daily operations and patient care of a single location.

While the French pharmaceutical model may appear more advantageous for patients, compared to the US, drug quality is drastically different. Indeed, herbal medicines account for roughly 65% of the French drug market. Yet many of these so-called remedies lack strong scientific backing. Scientific studies consistently show that most herbal products offer little more than a placebo effect, and some can even interfere with regular prescription medications. While the system may feel more natural and patient-friendly, a significant portion of the market is built on treatments whose benefits are unproven at best. My own experience with the “Freshers’ Flu” proves this point, as I was prescribed an herbal throat syrup that seemed more like pure honey than actual medication, and it did less than nothing to help.

Ultimately, an ideal system would combine the strengths of both countries’ pharmaceutical models – the US’s scientifically backed medications with France’s independently owned pharmacies. This duality would provide patients with the quality and innovation of US drug development, without the tedious experience of Big Pharma, alongside the affordability and personal care of French pharmacies. After all, who knew a glowing green cross and my naïve American misunderstanding could teach a Californian so much about the pharmaceutical world?