Once reimbursement is secured—or at least clearly on the horizon—the next strategic question quickly emerges to improve MedTech Go-to-Market in France: Should we build a direct sales team in France or work with a distributor?
At first glance, the answer may appear straightforward.
However, successful MedTech go-to-market in France depends on much more than commercial coverage.
In reality, the choice of commercial model influences market adoption, customer intimacy, reimbursement execution, evidence generation, and long-term growth.
Therefore, the real question is not simply “direct or distributor?”
It is: How much control do we need to make this therapy successful in France?
MedTech Go-to-Market in France: why France is different from other European markets
Many international MedTech companies assume that a European commercial strategy can be replicated across multiple countries.
However, this assumption often creates costly mistakes.
Indeed, France and Germany differ significantly from countries such as Italy or Spain, where distributor networks are often deeply embedded within the healthcare ecosystem.
France remains a market where manufacturers frequently maintain direct control over strategic activities.
Several factors explain this situation:
- France is one of the largest MedTech markets in Europe
- Selling prices are often relatively attractive
- Hospital payment terms are generally short
- Key accounts are highly concentrated
- Reimbursement discussions require long-term strategic involvement
As a result, many companies decide to maintain a stronger direct presence than they initially anticipated.
Assuming Europe is homogeneous is often the first strategic mistake.
Source: https://www.medtecheurope.org
Direct sales teams: maximizing control and customer intimacy
A direct sales model offers the highest level of control.
Specifically, companies can:
- maintain direct relationships with physicians and hospitals
- collect field intelligence more effectively
- control training and clinical support
- accelerate feedback loops
- protect strategic accounts
Furthermore, direct teams often contribute to evidence generation and support future reimbursement initiatives.
However, this model also requires greater investment, stronger management capabilities, and longer-term commitment.
Therefore, direct sales is generally most attractive when:
- the target market is sizeable
- procedures are complex
- physician training is critical
- customer intimacy creates value
Distributors: accelerating market access with lower fixed costs
Distributors remain an important option for many MedTech companies.
Indeed, specialized distributors may provide:
- existing hospital relationships
- local market knowledge
- commercial infrastructure
- logistical capabilities
- faster market deployment
However, companies should be careful not to assume that appointing a distributor means outsourcing market access responsibilities.
In France, reimbursement strategy should remain primarily driven by the manufacturer.
This is because reimbursement depends on:
- clinical evidence generation
- interactions with healthcare authorities
- KOL engagement
- long-term strategic positioning
Consequently, even when working through distributors, manufacturers should maintain control over reimbursement and adoption strategy.
Source: https://www.businessfrance.fr
The hybrid model: an increasingly attractive alternative
In practice, there is often a third option between building a direct subsidiary and appointing a distributor.
A hybrid model can combine strategic control with commercial flexibility.
For instance, companies may work with independent MedTech specialists who help:
- map target accounts
- engage key stakeholders
- open reference centers
- support early adoption
- facilitate reimbursement discussions
- generate market intelligence
This approach often allows companies to test the market before making larger organizational commitments.
Furthermore, it creates an opportunity to build awareness and adoption simultaneously.
Strategic Perspective: reimbursement and commercialization should remain connected
One common mistake is to treat reimbursement as completed once market access is achieved.
In reality, reimbursement and commercialization remain closely connected.
For example:
- KOL engagement continues after reimbursement
- real-world evidence generation often continues
- adoption dynamics influence future negotiations
- clinical champions remain essential
Therefore, the commercial model should support—not weaken—the broader reimbursement strategy.
Field Perspective: early adoption requires proximity
One lesson repeatedly observed in real-life MedTech projects is that early adoption often depends on proximity.
Hospitals rarely adopt innovative therapies based solely on product specifications.
Instead, they rely on:
- trusted relationships
- clinical support
- training
- procedural assistance
- peer-to-peer recommendations
Consequently, companies should evaluate whether their chosen commercial model provides sufficient proximity to support adoption.
Executive Perspective: control versus speed
For CEOs and VP Europe leaders, the strategic decision is often a balance between two competing objectives:
- speed of market deployment
- long-term control of execution
Distributors may accelerate deployment.
Direct teams may increase control.
Hybrid models may offer flexibility.
However, no model is universally superior.
The right answer depends on the therapy, the reimbursement pathway, the concentration of accounts, and the complexity of adoption.
Strategic Implications
The decision between direct sales, distributors, and hybrid models should never be reduced to a commercial discussion.
Instead, it is a strategic choice that influences:
- market access
- adoption
- customer intimacy
- evidence generation
- future growth
Ultimately, the chosen model should reinforce—not dilute—the company’s ability to execute its reimbursement and go-to-market strategy.
Strategic Takeaway
Successful MedTech go-to-market in France is not about choosing between a direct sales team and a distributor.
It is about selecting the level of control, proximity, and flexibility required to support long-term adoption.
Companies that align their commercial model with their reimbursement strategy are often better positioned to create sustainable growth.
Source: https://health.ec.europa.eu/medical-devices-sector_en
Related articles: https://www.caredis.fr/medtech-market-entry-in-france/, https://www.caredis.fr/medtech-reimbursement-in-france-right-pathway/, https://www.caredis.fr/medtech-reimbursement-in-france-right-pathway/
