Overnight leader Tadej Pogacar has a 3 minute 09 second advantage over defending champion Jonas Vingegaard while Remco Evenepoel remains third at 5min 19sec.
Philipsen and Girmay both have three stage wins but the Eritrean leads the rankings for the green jersey on 376pts to 344pts.
Girmay fell at a roundabout less than 2km out with two Education First riders.
His elbow was bleeding but the 24-year-old was able to remount and cruise home with a couple of team-mates, albeit ashen-faced.
The Tour de France race organisers extended the feared time cut Sunday to allow Mark Cavendish and other haggard stragglers to remain on the race and compete in Tuesday's flat stage, where 152 survivors of the first 15 stages departed.
But Tuesday's race was the last of the sprint stages with mountains galore on the menu from now on.
The race left the Gruissan salt basin with the mercury tipping 30 degrees Celsius (86 Fahrenheit) as the peloton rolled through the vineyards of the Aude region at speeds that fluctuated with the direction of the wind.
