China’s 2025 revision of the National Reimbursement Drug List (NRDL) has been the most competitive in history, with a record-setting number of candidates qualifying for the first round of formal review. Through mid-August 2025, there are more than 300 drugs for new listings and over 200 drugs for renewals and re-negotiation. In addition, over 100 drugs are trying to make the new C-list, which targets innovative and expensive drugs not currently covered by the NRDL. The unprecedented number of drugs reflects intense negotiations now and in the future, as drug manufacturers strive to secure reimbursement under increasingly tight budget conditions.
This year’s new C-list has already proven to be a game-changer. As a complement or back-up option for high-cost, high-value therapies, the C-list offers more flexible prices. As opposed to the NRDL’s requirement of blanket inclusion for lists A and B, the C-list can vary at the provincial level under China’s commercial health insurance (CHI). The C-list has the potential to be a driver for wider access, especially for expensive, rare disease and oncology medications that have not done well under the NRDL’s rigorous cost controls.
Oncology drugs are still the largest category. Rare disease contenders that include gene therapies for hemophilia B, innovative treatments for CDKL5 deficiency, etc., are now opting for the C-list to overcome the affordability barriers. In neurology, Alzheimer’s drugs Leqembi and Kisunla pursued both the NRDL and C-list platforms.
While the NRDL listing remains the standard for China drug market access, the C-list offers an alternative pathway that could redefine China’s access and reimbursement landscape for innovative drugs. However, how the C-list will be funded by insurance companies is still evolving.
Written by: Ames Gross – President and Founder, Pacific Bridge Medical (PBM)
Mr. Gross founded PBM in 1988 and has helped hundreds of medical companies with regulatory and business development issues in Asia. He is recognized nationally and internationally as a leader in the Asian medical markets. Mr. Gross has a BA degree, Phi Beta Kappa, from the University of Pennsylvania and an MBA from Columbia University.