Is NRDL Supporting Access or Hindering Access in China? A Time-Trend Analysis From 2017-2022

OBJECTIVES: The rapidly growing pharmaceutical market of China is an attractive market for many multinational companies (MNCs). As the main route for public reimbursement, inclusion in the National Reimbursement Drug List (NRDL) is key for pharmaceutical products to gain wide market access. Since 2017, NRDL’s scope has been expanded to cover innovative, patented drugs and has been updated in five consecutive years. This research examines NRDL outcomes over time.

METHODS: NRDL outcomes (2017–2022) were identified and key information extracted (17-May-2023).

RESULTS: The total number of medicines included in the NRDL increased by 15%, from 2571(2017) to 2967(2022). An average of 71 new medicines were added per year (range: 74[2021]–375[2017]), 52% of which were ‘Western’ medicines (i.e. non-traditional Chinese medicines). Average negotiation success rate was 80% (range: 65%[2019]–94%[2018]]). However, the average price cut negotiated was 56% and has risen from 44% in 2017 to 60% in 2022. Further, the proportion of negotiated medicines developed by MNCs dropped from 61% in 2017 to 32% in 2021.

CONCLUSIONS: Broader inclusion and policy updates show China’s supportive attitude towards providing access for innovative products. However, steep price cuts have been demanded, with prices subject to further decrease upon NRDL renewals. The growing domestic competition layers in extra hurdles for MNCs. To optimize access, it is increasingly important for MNCs to validate price-access trade-offs before pursuing coverage via the NRDL – by assessing the likely level of price discounts required, volume/revenue potential and implications for launch sequencing – with a long-term vision and lifecycle management strategy in place. Beyond the NRDL, MNCs should also consider alternative routes to patient access, such as commercial health insurance, crowdfunding and direct-to-patient financing – particularly in competitive areas with strong domestic presence.