OBJECTIVES: Hemophilia, a costly yet treatable rare disease, receives 100% reimbursement coverage in most developed world and some developing countries. The Chinese Ministry of Health announced in 2012 that 20 high-cost diseases (including hemophilia) should be prioritized to ease patients’ economic burdens. This study aims to understand the current reimbursement landscape for hemophilia in China and to explore potential funding mechanisms that could be expanded across China to improve reimbursement coverage to meet this requirement. METHODS: Hemophilia reimbursement policies of 3 major social insurance schemes were collected in 36 cities (provincial capitals and municipalities). In-depth interviews were conducted with selected government stakeholders to understand the rationale of different policies in different cities and implementation results. RESULTS: Outpatient hemophilia treatment is covered by health insurance schemes in more than 80% of the selected cities, yet with reimbursement caps and patient co-pay requirements. While there is significant variation by city, the average co-pay requirement is more than 50% and annual reimbursement is usually capped below USD16k (100k CNY). However, some cities have pioneered innovative policies to provide better coverage for hemophilia patients: Guangzhou health insurance bureau has decreased hemophilia co-payments to less than 10% after their extensive review of the economics of hemophilia treatment. The local health insurance bureau in Qingdao has decided to joint-fund prophylaxis treatment for pediatric patients together with a FVIII manufacturer. CONCLUSIONS: Hemophilia treatment reimbursement in China is still at a low level overall despite a few pioneer cities which have identified unique approaches to reducing the economic burden of patients living with hemophilia. There is significant room to increase reimbursement ratio and cap to reduce patients’ economic burden, and meanwhile we expect tailored public-private partnerships to be a promising supplementing solution.