OBJECTIVES: The Chinese oncology market is increasingly important to multinational and local pharmaceutical companies. However, access to high-cost medicines is fragmented within China. This study explored current prescribing and reimbursement of high-cost, targeted therapies and differences between Tier 1 and Tier 2/3 cities.   METHODS: Some 76 oncologists from different tier cities were surveyed regarding their current and expected future prescribing for gastric cancer (GC) and hepatocellular carcinoma (HCC). In addition, payers who influence reimbursement at national and/or regional levels were interviewed. RESULTS: Chemotherapy still dominates GC and HCC treatment in China, with limited use of high-cost targeted therapies; reimbursement is considered the greatest barrier to accessing targeted therapies. Almost 60% of HCC patients do not receive sorafenib due to cost/reimbursement-related reasons. Patient assistance programs and private insurance schemes, along with government initiatives such as negotiation for selective provincial formularies inclusion and “disastrous diseases” coverage will help break this barrier. Patient share of high-cost GC and HCC therapies is expected to double over the next three years. We also found disparity in access to cancer therapies between different tier cities. More patients in Tier 1 cities have urban resident basic medical insurance than in Tier 2/3 cities (34% versus 24%). In Tier 1 cities, relatively more patients receive targeted therapy (23% versus 16%), compared with Tier 2/3 cities. Another compounding factor is that the cost of these therapies is lower in Tier 1 cities than in most Tier 2/3 cities (trastuzumab costs $1800 per cycle in Shanghai versus $2500 in Shijiazhuang). CONCLUSIONS: There is huge opportunity for high-cost cancer therapies in China; however, uneven reimbursement between cities means local market access strategies are required to maximize patient share.