China's National Drug Price Negotiation Policy Dramatically Improves Access to Innovative Medicines While Reducing Costs by Up to 78%
核心洞察
China's National Drug Price Negotiation Policy significantly increased availability of negotiated drugs by 1.5-4.5 times and usage by 3-12 times across six rounds from 2016-2021.
The policy achieved substantial cost reductions with defined daily dose costs decreasing by up to 77.8% and price indices falling by as much as 51.7% immediately after implementation.
PCSK9 inhibitors evolocumab and alirocumab showed marked improvements in accessibility following their 2022 inclusion, with alirocumab demonstrating larger availability gains than evolocumab.
China's National Drug Price Negotiation Policy has achieved remarkable success in expanding access to innovative medicines while dramatically reducing costs, according to comprehensive nationwide studies evaluating the policy's impact from 2016 to 2021. The policy, which includes high-value patented medicines in the National Reimbursement Drug List through government-pharmaceutical company negotiations, has transformed the landscape for expensive therapeutic agents across Chinese hospitals.
Substantial Increases in Drug Availability and Usage
Analysis of 155 negotiated drugs across 698 hospitals nationwide revealed that the policy significantly increased both availability and utilization of targeted medicines. After inclusion in the National Reimbursement Drug List, the average defined daily doses of drugs from the six negotiation rounds were 3-12 times higher than before implementation, while availability rates increased by 1.5-4.5 times.
The most dramatic improvements occurred in later negotiation rounds, particularly those after 2018. The sixth round of negotiations showed the most substantial increase in usage, with utilization rising 13.36 times higher than the pre-intervention period. Four of the six rounds demonstrated significant immediate policy effects on availability, with rates increasing by 14.10% to 57.20% following implementation.
Despite these improvements, average drug availability across hospitals remained at 29.6% post-implementation, up from 11.36% before the policy. This suggests continued challenges in drug supply capabilities, though the low availability may partly reflect the specialized nature of many negotiated medicines, particularly oncology drugs typically prescribed in tertiary hospitals.
Dramatic Cost Reductions Achieved
The policy delivered on its primary objective of reducing financial burden on patients through substantial cost decreases. Defined daily dose costs decreased by up to 77.8% immediately following policy implementation, while price indices fell by as much as 51.7%. The average cost reductions across the six negotiation rounds ranged from 7.57% to 77.76% immediately after implementation.
Price negotiations consistently achieved significant reductions, with the success rate of national drug price negotiations remaining above 60% while maintaining average price reductions of approximately 60%. The Fisher price index analysis revealed immediate policy effects across all six rounds, with price decreases ranging from 2.15% to 51.72% upon implementation.
PCSK9 Inhibitors Demonstrate Policy Success
A focused analysis of PCSK9 inhibitors evolocumab and alirocumab, included in the National Reimbursement Drug List in December 2021, exemplifies the policy's effectiveness. Following their inclusion, both drugs showed substantial increases in availability, with alirocumab demonstrating larger improvement than evolocumab. The analysis of 910 tertiary and secondary hospitals across 31 provinces revealed persistent upward trends in defined daily doses for both medications.
Tertiary hospitals consistently showed higher utilization values than secondary hospitals, though the disparity in trend slopes between hospital tiers gradually narrowed over time. Both drugs experienced significant reductions in defined daily dose costs after policy implementation, with evolocumab showing a decrease of 53.587 and alirocumab declining by 79.280.
Policy Evolution and Institutional Strengthening
The policy's impact varied across different negotiation rounds, with stronger immediate effects observed for drugs negotiated after 2018. This coincided with the establishment of China's National Healthcare Security Administration (搜索), which enhanced policy enforcement capabilities. The administration introduced complementary measures including a dual-channel system allowing patients to obtain negotiated medicines through both hospitals and designated retail pharmacies with equivalent reimbursement.
The negotiation process has evolved from expert-selected candidates to enterprise-initiated applications since 2020, where pharmaceutical companies meeting eligibility criteria voluntarily submit applications. Negotiations involve multidisciplinary experts who evaluate therapeutic value and cost-effectiveness before determining reimbursed prices.
Challenges and Future Considerations
While the policy achieved its primary objectives, several challenges remain. The rate of decline in both price indices and defined daily dose costs slowed over time in later policy stages. Researchers propose this may reflect efforts to balance drug innovation incentives with affordability, as perpetual price reductions could discourage pharmaceutical innovation.
The analysis revealed that 70% of the 100 negotiated drugs renewed in 2023 maintained original prices, while discounted varieties experienced an average price reduction of only 6.7%. This moderation suggests regulatory authorities are increasingly considering the need to protect innovation incentives while maintaining affordability.
Implications for Healthcare Equity
The policy has progressively narrowed disparities in adoption and utilization of innovative medicines across different hospital tiers, thereby advancing equitable health outcomes. The gap between tertiary and secondary hospitals in PCSK9 inhibitor utilization gradually decreased over time, indicating improved access across the healthcare system.
However, the relatively low overall availability rates suggest continued need for enhanced drug supply capabilities to fully meet patient demands. The specialized nature of many negotiated drugs, particularly oncology medicines (搜索) typically prescribed in tertiary hospitals, may contribute to lower availability assessments when measured across all hospital types.
The comprehensive evaluation demonstrates that China's National Drug Price Negotiation Policy has successfully achieved its dual objectives of expanding access to innovative medicines while reducing financial burden on patients, though continued efforts are needed to optimize drug supply and monitor long-term price stability.