OBJECTIVES: China has adopted health technology assessment (HTA) as the key instrument in drug listing decision-making processes for social health insurance before the final price negotiation. However, the relative importance of criteria for reimbursement decisions is not made explicit. This study aimed to identify the factors that influence the National Medical Insurance Drug List (NMIDL) decisions.

METHODS: We reviewed the publicly available information about exclusive drugs that applied for NMIDL price negotiations in 2020. For each drug, proxies for drug basic characteristics (drug type, preparation form, type of manufacturer), innovation value (approved time, classification defined by Chinese government, number of comparators already in the NMIDL, urgently needed new overseas drugs), therapeutic indications (rare disease, chronic disease) and economic burden (annual treatment costs) were collected. The final reimbursement decisions made by the National Health Care Security Administration (NHSA) were dichotomized into ‘listing’ or ‘rejection’. Chi-square tests and logistic modeling were used to determine factors associated with reimbursement decisions.

RESULTS: Of the 143 applied drugs, 59 (41.3%) were finally successfully listed in the NMIDL. Three characteristics of drugs were strongly associated with listing decisions: drugs for chronic diseases (OR=4.52), innovative drugs (OR=5.17), and drugs with annual treatment cost higher than 3 times the per-capita GDP (OR=0.13).

CONCLUSIONS: High annual treatment cost was an important reason for rejection due to the excessive financial burden on medical insurance funds. Being an innovative drug was the strongest positive predictor of reimbursement because of better clinical value. Drugs for chronic use met extensive clinic needs, and this was thus an important factor affecting reimbursement decision making. Although the impact of HTA on reimbursement outcomes is still unclear, our study suggests that key elements of HTA, including disease need, clinical value, and affordability, are highly correlated with drug listing decisions.