OBJECTIVES: On 1 June 2015, Chinese regulators (National Development and Reform Commission, Ministry of Human Resources and Social Security, National Health and Family Planning Commission) removed the price ceiling of most drugs in hopes of establishing a market-driven pricing system that will help keep medical costs in check. In order to better control the drug expenditure of medical insurance funds, the drug price established through the public bidding process for new drug purchasing establishes the reimbursement cap, which is called the “reimbursement standard”. And, under a new therapeutic reference pricing policy, only price will be used to differentiate products if they are considered similar. Thus, sustainable access to products may be at risk. The objective of this research is to understand how this system is being applied and implemented across provinces. METHODS: Secondary research analysis reviewed the policy, its evolution and the reimbursement standard achieved in three pilot areas, Chongqing, Jiangsu and Zhejiang. In-depth interviews were conducted with relevant government stakeholders to understand variation in provincial policy and implementation results across the pilot areas. RESULTS: At the national level, MOHRSS has designed a top-down framework utilizing the reimbursement standard. Local pooling areas will enact this framework through tailored policies at the provincial and municipal level. However, MOHRSS has little historical drug procurement data to predict or anticipate the likely bids and hence establish the optimal reimbursement cap. Therefore, sustainable access to innovative products may only be achieved if companies collect real world data and conduct pharmaco-economic (PE) studies to support value-based decision-making and assist MOHRSS in establishing optimal reimbursement caps at the local level.  CONCLUSIONS: Under the new pricing, procurement and reimbursement mechanism, sustainable access to products will require strategic initiatives to substantiate the differentiated value of innovative products and motivate the need for a separate reimbursement standard for differentiated products.