Medications for COVID‑19, rare diseases, and other conditions have been added to the national medical insurance catalog, with average price reductions exceeding 60%—an analysis of the key highlights of the latest edition of the National Medical Insurance Drug List.

　　Xinhua News Agency reporters Peng Yunjia and Gu Tiancheng

　　Antiviral drugs for COVID‑19, such as Azvudine tablets, have been included in the national medical insurance scheme, and newly negotiated or competitively priced medications have seen an average price reduction of 60.1%. Over the next two years, this is expected to ease patients’ financial burden by more than RMB 90 billion. The latest edition of the National Reimbursement Drug List was unveiled in Beijing on the 18th. What key highlights of the new list deserve attention, and what impact will it have on patients’ access to medicines? The National Healthcare Security Administration held a press conference that day to address these questions.

　　111 drugs have been included, covering multiple therapeutic areas including COVID-19 and rare diseases.

　　Currently, the updated National Reimbursement Drug List includes a total of 2,967 medications, with new additions covering two drugs for COVID‑19 treatment, seven rare disease medications, and 22 pediatric medicines, among others. Following this round of negotiations, Azvudine tablets and Qingfei Paidu Granules have been included in the list, bringing the total number of drugs listed for treating COVID‑19 symptoms such as fever and cough to over 600.

　　“The 2022 formulary adjustment supports key therapeutic areas, including domestically developed innovative drugs, COVID‑19 treatments, and pediatric medications,” said Huang Xinyu, Deputy Director of the Pharmaceutical Services Management Department of the National Healthcare Security Administration. He added that medicines for major diseases such as cancer and rare disorders, as well as those for chronic conditions like diabetes and chronic obstructive pulmonary disease, have been included in the new version of the formulary, which will further enhance the level of coverage.

　　In the previous edition of the National Reimbursement Drug List, Nusinersen sodium injection—formerly priced at 700,000 yuan per dose for the treatment of spinal muscular atrophy—was included in the national medical insurance scheme after price negotiations, at a cost of just over 30,000 yuan.

　　As a competitor to nusinersen sodium injection, risdiplam—also indicated for the treatment of spinal muscular atrophy—has been successfully included in the latest edition of the National Reimbursement Drug List. Administered according to age and body weight, this medication offers greater cost-effectiveness for younger pediatric patients with lower body weights.

　　According to the announcement, the vast majority of the drugs newly added to this formulary were launched within the past five years. Among the 111 newly included medications, 23 were approved in 2022 and were promptly incorporated into that year’s list. Additionally, negotiations for 20 domestically developed, major innovative drugs were successful, with a success rate of 83.3%, which exceeds the overall negotiation success rate.

　　In the oncology field, this round of negotiations not only added new drugs with remarkable efficacy, such as lorlatinib, but also saw significant price reductions for previously listed medications like ensartinib. Take sintilimab, manufactured by Innovent Biologics, as an example: this drug covers high-incidence cancers including lung, gastric, and esophageal cancers, and its post‑reimbursement cost has dropped substantially, benefiting a greater number of patients.

　　Average price cuts of 60%: Health insurance negotiations do not blindly pursue “rock-bottom prices.”

　　“The price reductions for newly added drugs subject to negotiation and bidding reached 60.1%, roughly on par with last year, combining the dual benefits of negotiated price cuts and expanded medical insurance reimbursement.” According to Huang Xinyu, over the next two years, the updated national medical insurance drug list is expected to alleviate patients’ financial burdens by more than RMB 90 billion.

　　As a malignant hematopoietic stem cell disorder characterized primarily by myeloid proliferation, China sees approximately 1,000 new cases of chronic myeloid leukemia with the T315I mutation each year, leaving patients facing the long-standing challenge of having no effective treatment options.

　　After more than an hour of on-site negotiations, Yasheng Pharmaceutical’s olrebatinib was successfully negotiated. This is China’s first domestically developed innovative drug for the treatment of chronic myeloid leukemia harboring the T315I mutation, filling a gap in the national medical insurance drug list. Compared with its previous retail price, the annual treatment cost has been reduced by nearly 50%, further easing the financial burden on patients.

　　Under the current medical insurance negotiation rules, once a company’s bid reaches 115% of the insurance fund’s floor price in either of the two rounds, it may proceed to the consultation phase. The final agreed-upon price must not exceed the insurance fund’s negotiated floor price in order for the negotiation to be deemed successful.

　　The negotiated floor price is the maximum price that the medical insurance fund can afford. It is determined through expert assessments conducted by the medical insurance authorities, taking into account factors such as drug cost-effectiveness, budgetary impact, and the financial burden on the medical insurance fund, rather than simply pursuing the lowest possible price. To date, negotiations have resulted in average price reductions of over 50% for 250 new drugs, which have since been included in the medical insurance reimbursement scheme.

　　“Every penny negotiated is life‑saving money for the people,” said Li Hao, one of the heads of the medical insurance negotiation team and Director of the Pharmaceutical Pricing and Procurement Division at the Qingdao Municipal Healthcare Security Bureau. By leveraging its strategic purchasing power, medical insurance negotiations enable a win‑win outcome for the government, enterprises, patients, and other stakeholders.

　　Notably, in 2022, the national medical insurance drug list adjustment introduced, for the first time, rules for competitive bidding access. Non‑exclusive drugs not previously on the list could be added after a uniform payment standard was established through bidding; a total of 17 such drugs were included, with an average price reduction of 60.5%.

　　Dynamic adjustment of the formulary promotes rational clinical drug use, and the national scope of drugs covered by medical insurance has been largely standardized.

　　According to the latest reports, the revised National Reimbursement Drug List will officially take effect on March 1, 2023.

　　In recent years, China’s healthcare security system has expanded rapidly, with the National Reimbursement Drug List undergoing annual dynamic adjustments. Over the past five years, the number of drugs included in the list has increased by 618, encompassing 310 medications for chronic conditions such as hypertension, diabetes, and mental disorders, 93 oncology drugs, and 22 drugs for rare diseases, among others.

　　Huang Xinyu stated that over the past five years, the national medical insurance drug list has increasingly demonstrated its role in guiding the rational use of medications in clinical practice, leading to significant and positive changes in hospital prescribing patterns and aligning them more closely with China’s pharmaceutical burden and healthcare needs.

　　According to reports, monitoring data from a sample of hospitals indicate that, over the past five years, both the share of drug usage and the total expenditure on drugs listed in the formulary have increased year by year. Among the top 20 highest‑cost drug categories in medical institutions, there are now very few ancillary medications with uncertain efficacy or prone to misuse; these have been largely replaced by therapeutic agents used in oncology, hypertension, diabetes, and other therapeutic areas.

　　By the end of 2022, all provinces nationwide had completed the process of phasing out locally added drugs, thereby achieving basic national uniformity in the scope of drugs covered by basic medical insurance. Following price negotiations, drug prices were significantly reduced, and most locally added medications can now be effectively replaced by those included in the national formulary.

　　Cao Zhuang, Director of the Pharmaceutical Management Division at the National Institute for Medical Insurance of Capital Medical University, stated that the near‑uniform nationwide scope of drugs covered by basic medical insurance facilitates drug management under the system, promotes cross‑regional medical care, hospital settlement, and cost‑statistical analysis, and enhances the strategic purchasing function of national medical insurance.