OBJECTIVES: Inclusion in the National Reimbursement Drug List (NRDL) is main route for public reimbursement of pharmaceutical products in mainland China. In Hong Kong, a special administrative region in China, only the Hospital Authority Drug Formulary is the primary route of public reimbursement. This research compares reimbursement outcomes between mainland China and Hong Kong.

METHODS: Reimbursement outcomes from the NRDL 2022 and the Hong Kong Hospital Authority Drug Formulary (version 23-May-2023) were identified with key information extracted (12-June-2023).

RESULTS: In the NRDL, 2,967 medicines are reimbursed, including 1,381 Traditional Chinese Medicines and 1,586 Western Medicines. In Hong Kong, on the Hospital Authority Drug Formulary, 924 general drugs are fully reimbursed, 403 special drugs are reimbursed with certain conditions, and 107 Safety Net Financial Assistance (SFI) drugs are exclusively reimbursed for patients facing financial difficulties. Notably, among the 111 new entrants in the NRDL 2022, only 39 (35%) are reimbursed in Hong Kong. Out of the 14 new oncology NRDL entrants, only 5 (36%) receive reimbursement in Hong Kong. Among the 7 new rare disease entrants, only 3 (43%) are reimbursed, with Evrysdi being reimbursed under special programmes for individual patients in Hong Kong when no reimbursement restrictions are applied in mainland China.

CONCLUSIONS: The comparison of pharmaceutical reimbursement between mainland China and Hong Kong reveals notable differences, with the NRDL providing broader access, while Hong Kong's coverage appears to be less diverse and more limited, particularly for high-cost drugs. While fewer innovative therapies are reimbursed in Hong Kong, the recent initiative of the Greater Bay Area offering an early access route may present opportunities for companies to explore accelerated market entry, enabling them to enhance market presence and maximize commercial opportunities in the region.