OBJECTIVES: In China, price negotiations are mandatory for originator drugs to be listed on the National Reimbursement Drug List (NRDL). The process to determine a reimbursement price is not transparent; therefore, this study aims to explore various measures that can influence drug prices in a successful price negotiation.

METHODS: Primary research was conducted to explore measures influencing reimbursement price in China. Three payers were recruited to assess the perspectives from a national, regional, and commercial insurance level.

RESULTS: A confidential reserve price is determined by the National Healthcare Security Administration (NHSA) during the final stages of a price negotiation. The manufacturer will have two opportunities to present an offer within 15% of the reserve price, otherwise the price negotiation will terminate. Payer feedback suggests that the reserve price is determined by measures including the price of comparator, health economic evaluations, and international reference pricing (IRP); the lowest price from the three options will likely be considered. Comparator drugs are chosen early on in the NRDL assessment, and are based on NRDL listings, the disease the comparator is indicated for, and whether it is classed as a “gold standard”. Further, the NHSA often benchmarks the reserve price against the lowest visible price in a reference basket of 12 countries including Australia, Canada, France, Germany, Italy, Japan, South Korea, Spain, Taiwan, Turkey, United Kingdom, and United States. Payer feedback suggest that prices in China are closely benchmarked to South Korea and Turkey.

CONCLUSIONS: Although the specific metric to determine reserve price for price negotiation is not transparent, three measures have been identified to determine reimbursement price. Manufacturers should consider these measures, in addition to a ‘walk-away’ price, when preparing for price negotiations with the NHSA.