Prices of drugs sold in China will drop by 61.7% on average this year, as the latest update to China’s National Reimbursement Drug List (NRDL) goes into effect. But while the price cut—the most significant slash since 2017 — is a blow to foreign pharma manufacturers, those producing rare disease treatments can expect a sales boost in China, after a raft of Orphan drug products were added to the reimbursement list.
The NRDL, overseen by the National Healthcare Security Administration (NHSA), determines which drugs will be reimbursed by the country’s health care system. Negotiated drugs are covered in the NRDL for two years and can be renewed through new negotiations after expiration.
Approved in December, the NRDL update includes a total of 2,860 drugs, of which 1,486 are Western drugs. On the list are innovative drugs for oncology, infectious and rare diseases. But in a reminder of how China uses the list to boost domestic firms, for the fourth year in a row anti-cancer drugs known as PD-1/L1 inhibitors produced by foreign firms have been excluded — while the number of domestically produced competitors of such treatments listed has increased.
The NRDL was first established in 2000 with the aim of improving access and reimbursement for hospital-purchased drugs. It was updated only three times before 2017 and initially focused mostly on the reimbursement of generic drugs. But since then, regular annual updates and the inclusion of many premium-priced, innovative therapies have made it a critical gateway to the Chinese market.