OBJECTIVES: China further expanded universal health insurance in 2014 with 1,387 million citizens now eligible for Basic Medical Insurance (BMI) and a coverage rate of over 97%. The patients covered by BMI have access to drugs listed on the NDRL (National Drug Reimbursement List). However, inclusion criteria for listing on the NDRL are very strict and the list has not been revised since 2009. Therefore, understanding alternative strategies and approaches for increasing the probability of Provincial Drug Reimbursement List (PDRL) inclusion is essential.  METHODS: This analysis includes a review of secondary data of PDRL inclusion in 6 key provinces in China: Zhejiang, Jiangsu, Fujian, Shandong, Anhui and Jiangxi and is supplemented with primary research with regional payers and payer advising KOLs to assess the PDRL inclusion criteria as an alternative market access strategy to the NDRL.  RESULTS: In contrast to the NDRL, the PDRLs are revised on a more regular basis and have less restrictive inclusion criteria. Important criteria for assessment are aligned with substantiating and communicating product value in the areas of efficacy, effectiveness, safety and not surprisingly, price. Interviews with stakeholders identify the importance of real world data and pharmaco-economic (PE) studies in decision making with the priority of identifying cost offsets and cost effective use of insurance funding.  CONCLUSIONS: Given the current environment, healthcare stakeholders are eager for PE studies that support and lend credibility to value-based decision-making. While NDRL remains an elusive goal for access, PDRL inclusion may be a more realistic alternative with the probability for success enhanced by providing locally-relevant pharmaco-economic studies completed in conjunction with local authorities and KOLs.