The New Challenges of AMO

The social protection reform is still ongoing. The first milestone of Mandatory Health Insurance (AMO) ⁽¹⁾ was its generalization. Today, 32 million Moroccans out of the country’s 36 million population are covered. The next step is to extend this coverage to the remaining 4 million individuals. To achieve this, CGEM (General Confederation of Moroccan Enterprises) and other professional federations, particularly in agriculture, transport, and craftsmanship, have a crucial role in integrating this population into the system. According to a source close to the matter, the current challenge is to expand the contributor base to ensure the system’s financial balance. For those under AMO-Tadamon (previously RAMED beneficiaries), who lack the financial means to pay premiums, the state covers their contributions. However, in the self-employed workers’ scheme, 3.7 million people (including dependents) have been registered, yet only 500,000 actively contribute. Another scheme, AMO Chamil, targets individuals who are neither salaried employees nor self-employed workers but have the ability to pay their contributions. These individuals must go through the Unified Social Registry (RSU), which assigns a contribution score based on their financial capacity. For most, the monthly contribution does not exceed 170 DH. However, only 150,000 people have enrolled in AMO Chamil so far, while the government’s target is 4 million contributors. The challenge remains to secure regular payments, requiring joint efforts to expand enrollment.
The second major challenge for AMO lies in controlling healthcare costs, which includes two primary aspects. First one is about medicines which account for 30% of AMO’s total expenditures. To address this, the Ministry of Finance conducted a study identifying key areas for reducing drug prices. One of the main recommendations is to base reimbursements on generic drugs rather than branded (princeps) medications. To implement this change, pharmacists must be granted substitution rights. For instance, if a doctor prescribes a branded drug costing 200 DH, while the generic equivalent is only 60 DH, the pharmacist should be allowed to substitute it with the cheaper alternative. Since reimbursements are calculated based on the lowest-cost medication, this shift is essential to maintaining AMO’s financial sustainability.
A revision of existing regulations is necessary to legally empower pharmacists to make substitutions where appropriate.
Beyond generic substitution, another crucial aspect is the revision of pricing models to reduce excessively high profit margins in the pharmaceutical sector. Addressing these pricing mechanisms will be a key lever for cost reduction within AMO.

(1) AMO stands in French for Assurance Maladie Obligatoire.

Mohamed CHAOUI