The Paris Court of Appeal (“Court of Appeals”) has issued its ruling on damages in the Plavix follow-on action brought by France’s national health insurance fund (the “CNAM”) against Sanofi.[1] More than a decade after the French Competition Authority (“FCA”) found that Sanofi had engaged in disparagement practices constituting an abuse of dominant position, the Court awarded the CNAM €150.7 million, reflecting the long-term impact of Sanofi’s conduct. The judgment highlights the magnitude of potential damages in follow-on actions and illustrates how French courts evaluate long-lasting effects and the full-compensation principle.

Background

On May 14, 2013, the FCA imposed a €40.6 million fine on Sanofi-Aventis (“Sanofi”) for abusing its dominant position in the French market for clopidogrel sold in retail pharmacies.[2] Clopidogrel is an active ingredient used in antiplatelet medication to prevent recurring cardiovascular diseases. It was marketed for the first time by Sanofi under the brand name Plavix.

In 2008, Plavix accounted for the CNAM’s largest reimbursement expenditure, totaling €635 million.[3] The patent protecting Plavix in Europe expired in July 2008, and the first Plavix generics were placed on the market in early October 2009, including by Sanofi itself.[4]

The FCA found that, between September 2009 and January 2010, Sanofi had implemented a 5-month-long communication campaign disparaging generic drugs other than its own.[5]

Sanofi circulated briefing materials to its medical representatives and pharmaceutical sales teams setting out the differences between Plavix and its generic counterparts. The FCA found that these materials cast doubt on the generics’ bioequivalence. Among other things, the materials noted (i) that the generics used a different salt form and (ii) that their marketing authorizations did not include the treatment of acute coronary syndromes in combination with aspirin.[6]

According to the FCA, these two points were presented in a connected and ambiguous manner. The FCA considered that, as a result, healthcare professionals were liable to understand that the absence of the acute coronary syndrome indication reflected a medical or safety concern linked to the different salt form. In fact, however, that absence was explained solely by the existence of a still-valid patent protecting the relevant therapeutic indication.[7]

The FCA concluded that Sanofi had engaged in disparagement both (i) at the prescription stage, by encouraging doctors to write “non-substitutable” on prescriptions, and (ii) at the substitution stage, by encouraging pharmacists to dispense Sanofi’s generic in place of competing generics.[8]

The FCA’s decision was confirmed by the Court of Appeals on December 18, 2014,[9] and Sanofi’s subsequent appeal before the French Court of Cassation was rejected.[10]

In September 2017, the CNAM initiated damages proceedings before the Paris Commercial Court, seeking compensation for the harm allegedly caused by Sanofi’s conduct. The CNAM’s claim, initially dismissed as time-barred, was reinstated on appeal, and the Court of Appeals held that Sanofi’s practices constituted faults and adversely affected the CNAM.[11]

The Court of Appeals, however, reserved its decision on the quantification of damages and ordered an expert report to assess (i) the robustness of the counterfactual scenario produced by the CNAM, (ii) the duration of the conduct’s effects on the CNAM, and (iii) the financial impact on the CNAM in terms of patient reimbursements and pharmacists’ remuneration.

The court-appointed expert filed its report on March 5, 2024 and the Court of Appeals issued its ruling on September 24, 2025.

The Ruling

The court-appointed expert validated nearly all aspects of the CNAM’s analysis concerning the three categories of harm.

Reimbursement of insured persons. The CNAM claimed that it had incurred a loss linked to the reimbursement of insured persons, since the price of originator drugs is higher than that of generics. This loss corresponds to the difference between (i) the amount the CNAM actually spent reimbursing clopidogrel and (ii) the amount it would have spent had clopidogrel followed a normal trajectory of generic entry and penetration.

The expert accepted the CNAM’s position that, although Sanofi’s anticompetitive practices lasted only five months, their effects were long-lasting and could be measured until around September 2021.

This conclusion was based on a comparison between the observed generic penetration rate and a counterfactual penetration rate, defined as the level of generic substitution that would have been expected in the absence of the unlawful conduct. That counterfactual rate was estimated by reference to comparable pharmaceutical molecules unaffected by the practices. The effects were considered to persist for as long as a measurable gap remained between these two trajectories, which converged only at the end of the period analyzed.

On this basis, the CNAM sought €111.6 million in compensation for excess reimbursement expenditures.[12]

Sanofi challenged this assessment, notably by arguing that the expert had failed to consider that the CNAM allegedly also benefited from the anticompetitive practices. Sanofi relied on the principle of full compensation, which states that damages awarded to a party must fully repair the loss suffered without resulting in either a gain or a loss for that party.[13]

Sanofi argued that three price reductions imposed on Plavix by the public authorities should have been taken into account in the assessment of damages. Sanofi claimed those reductions were triggered by the unusually low rate of substitution of Plavix by generics, as part of the regulatory price-setting mechanism applicable to reimbursable medicines in France. Because these imposed price cuts reduced the reimbursement amounts borne by the CNAM, Sanofi contended that they constituted a financial benefit for the CNAM and should therefore be deducted from the CNAM’s alleged loss.[14]

The Court of Appeals however held that Sanofi had not demonstrated that these price reductions were directly and solely linked to an insufficient substitution rate and rejected the argument.[15]

The Court of Appeals, dismissing all of Sanofi’s arguments, validated the expert’s assessment that the CNAM’s report — which estimated the loss related to excess reimbursement of insured persons at €111.6 million — was methodologically robust.[16]

Pharmacist remuneration.The CNAM further argued that it had incurred additional costs linked to the remuneration of pharmacists. Under a remuneration scheme introduced in 2012, pharmacists received performance-based payments calculated by reference to their progress in dispensing generic medicines over time, including clopidogrel.

Because Sanofi’s practices delayed the penetration of generic Plavix, the initial level of generic dispensing was artificially low when the scheme entered into force. As a result, subsequent increases in generic dispensing generated larger measured ‘progress’ and, mechanically, higher performance-related payments by the CNAM than would have occurred under normal competitive conditions.[17]

As a result, the Court of Appeals found that Sanofi’s practices directly increased CNAM’s remuneration costs and upheld the expert’s assessment that the CNAM’s report — which estimated the loss related to the excess remuneration of pharmacists at €14.5 million — was robust.[18]

Statutory interest. Finally, the CNAM sought statutory interest to compensate for the financial harm arising from the delayed recovery of the sums owed. The Court of Appeals accepted the CNAM’s methodology and awarded compensatory interest for the period from January 1, 2010 to June 30, 2025, amounting to €21 million for excess reimbursement costs and €2.5 million for excess pharmacist remuneration.[19]

Total compensation. In total, the Court of Appeals ordered Sanofi to pay the CNAM €150.7 million in damages. This amount will accrue legal interest from the date of the ruling pursuant to Article 1231-7 of the French Civil Code.[20]

This ruling may be subject to appeal before the French Cour de cassation.

Takeaways

• High damages exposure. The Court of Appeals awarded the CNAM 150.7 million euros, more than four times the FCA fine, underscoring that follow-on damages actions can generate liability far exceeding the initial antitrust fine. Companies should anticipate that private damages — particularly in markets with high volumes and sustained effects — may represent the most significant financial risk of anticompetitive practices.

• Long-term impact of short-lived conduct. The ruling illustrates that even brief anticompetitive practices can produce long-lasting market distortions, meaning that short episodes of anticompetitive behavior can translate into multi-year damages exposure. Similar to the Plavix case, in Orange v. Digicel, the Court of Appeals found that exclusionary practices implemented over a limited period continued to affect competition well beyond their cessation.[21] In that case, the damages awarded to Digicel also significantly exceeded the fine imposed by the French Competition Authority.

• Full-compensation principle may reduce claims. Under the full-compensation principle, French courts may consider whether a claimant also benefited — directly or indirectly — from the conduct at issue, potentially reducing the recoverable harm. Parties should therefore expect arguments on claimant benefits to feature in follow-on litigation and to be assessed through detailed economic analysis.

---

[1] Paris Court of Appeal, September 24, 2025, RG n°19/19969, CNAM v. Sanofi.

[2] FCA Decision n° 13-D-11 of May 14, 2013, regarding practices implemented in the pharmaceutical

sector, available here.

[3] FCA Decision n° 13-D-11 of May 14, 2013, paragraph 47.

[4] Paris Court of Appeal, September 24, 2025, RG n°19/19969, CNAM v. Sanofi, paragraph 3.

[5] FCA Decision n° 13-D-11 of May 14, 2013, paragraph 584.

[6] FCA Decision n° 13-D-11 of May 14, 2013, paragraph 118.

[7] Paris Court of Appeal, September 24, 2025, RG n°19/19969, CNAM v. Sanofi, paragraph 33.

[8] Paris Court of Appeal, September 24, 2025, RG n°19/19969, CNAM v. Sanofi, paragraph 30.

[9] Paris Court of Appeal, December 18, 2014, RG n°2013/12370, Sanofi v. FCA and Teva Santé.

[10] French Cour de cassation, October 18, 2016, Appeal n°15-10.384, Sanofi v. FCA and Teva Santé.

[11] Paris Court of Appeal, February 19, 2022, RG n°19/19969, CNAM v. Sanofi.

[12] Paris Court of Appeal, September 24, 2025, RG n°19/19969, CNAM v. Sanofi, para. 235.

[13] Paris Court of Appeal, September 24, 2025, RG n°19/19969, CNAM v. Sanofi, para. 172.

[14] Paris Court of Appeal, September 24, 2025, RG n°19/19969, CNAM v. Sanofi, para. 173.

[15] Paris Court of Appeal, September 24, 2025, RG n°19/19969, CNAM v. Sanofi, para. 225.

[16] Paris Court of Appeal, September 24, 2025, RG n°19/19969, CNAM v. Sanofi, para. 239.

[17] Paris Court of Appeal, September 24, 2025, RG n°19/19969, CNAM v. Sanofi, para. 244.

[18] Paris Court of Appeal, September 24, 2025, RG n°19/19969, CNAM v. Sanofi, para. 247.

[19] Paris Court of Appeal, September 24, 2025, RG n°19/19969, CNAM v. Sanofi, paras 267.

[20] Paris Court of Appeal, September 24, 2025, RG n°19/19969, CNAM v. Sanofi, paras 268.

[21] Paris Court of Appeal, June 17, 2020, RG n°17/23041, Orange and Orange Caraïbe v. Digicel Antilles Françaises Guyane, upheld on this point by the French Cour de cassation, March 1, 2023, Appeal n°20-18.356 and 20-20.416 (joined).