Presentation (CTI)

OBJECTIVES: China introduced the Commercial Insurance Innovative Drug List (CIIDL) in 2025 to complement basic medical insurance and support access to high-cost innovative medicines exceeding the “basic coverage” remit of the National Reimbursement Drug List (NRDL). This study evaluates early implementation challenges after the first CIIDL cycle and assesses implications for multi-payer access strategy.
METHODS: A structured policy and secondary data review was conducted using 2025-2026 CIIDL workplans, official list publications, application data, and early implementation reporting. The analysis assessed challenges across three dimensions: manufacturer participation, hospital adoption, and commercial insurance integration.
RESULTS: The first CIIDL cycle showed strong interest but high selectivity: 141 drugs were submitted, 121 passed formal review, 24 entered price negotiations, and 19 were included, mainly covering oncology, rare diseases, and Alzheimer’s disease. In 2026, applications fell to 61, including 17 CIIDL-only and 44 dual NRDL/CIIDL submissions, suggesting a shift toward more selective manufacturer decision-making. Implementation barriers appear concentrated beyond national policy design. Although CIIDL provides a reference list for commercial insurance, inclusion does not guarantee reimbursement, as insurers retain discretion over coverage. Hospital uptake remains uneven: early reporting showed 223 equipped institutions by January 2026, with 12.3% tertiary-hospital coverage and less than 1% primary-care coverage, indicating a gap between listing and provider-level use. Payer capacity is another constraint: commercial insurance remains a limited funding source, with coverage at less than 10% of pharmaceutical sales, compared with larger public insurance and out-of-pocket shares.
CONCLUSIONS: CIIDL represents an important step toward a dual-track access model in China, but first-year implementation highlights a “last-mile” challenge: national listing alone does not ensure payer adoption, hospital prescribing, or patient-level reimbursement. For manufacturers, CIIDL should be viewed as an early access, value-generation, and transition pathway. Its long-term impact will depend on stronger insurer uptake, clearer hospital incentives, and scalable risk-sharing mechanisms.