China updates national drug list, adding some blockbuster Western meds

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China updates its National Reimbursement Drug List after about eight years.

China has updated its list of medicines covered by national medical insurance, adding some new drugs with a focus on pediatrics and major illnesses such as cancer, hepatitis, and renal and cardiovascular diseases, including some from companies like GlaxoSmithKline and AstraZeneca.

The overhaul, the first since late 2009, saw the number of "Western-style" and traditional Chinese medicines included in the list grow by 15% to 2,535, among which 1,297 are Western-style meds, an 11% increase.

The additions include some blockbuster meds like tenofovir, an antiviral drug to treat hepatitis B and HIV, and marketed by GSK as Viread; and cancer drug gefitinib, sold under the brand name Iressa by AstraZeneca. China’s own non-small cell lung cancer med icotinib (Conmana), approved by China’s FDA in 2011, is also included.

Also added to the list (Chinese) are 91 pediatric meds, growing that category to 540, according to a spokesperson from the Ministry of Human Resources and Social Security, as reported (Chinese) by China state news agency Xinhua.

The ministry also put 45 drugs on a “to-be-negotiated” list, half of which are targeted cancer therapies, according to Xinhua. Once agreements are reached between the government and drugmakers, those meds could also be included.

The ministry said inclusions of new drugs would reduce the financial burden on patients and help support innovations in China's pharmaceutical market. Valued at $105 billion in 2014, the country’s pharma market currently ranks second globally in terms of size, trailing right behind the U.S., and will likely increase dramatically to $200 billion by 2020, according to a 2015 report by Research and Markets.

Unlike the U.S., where medical insurance is provided by for-profit companies, China has a national medical insurance program. The National Reimbursement Drug List (NRDL) names all the drugs covered by the insurance program, some in full (type A drugs) and others partially (type B). Patients must pay the full price out of pocket for those drugs outside the list, which means a huge financial burden, especially when new but more effective drugs are not covered.

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In an effort to keep the insurance fund in balance, the Chinese government has been pressuring drug prices hard. Even though inclusion on the NRDL usually entails a huge price cut during pharma companies’ negotiations with the government, the potential market expansion can still be enticing.

GSK, for example, cut Viread’s price in China by two-thirds last year, a move that obviously helped it earn a place in the updated drug list.

Hepatitis B is one of the most widespread infectious diseases in China, with about 90 million people carrying the virus and 28 million chronic hepatitis B patients, according to the country’s CDC in 2015.

GSK has “already seen a major increase in the uptake” of Viread in China after the price cut, a company spokesperson said, as quoted by Reuters in a story about the list update.

Provincial-level governments are now requested to make their own lists by the end of July of this year. They can tweak a bit of the national list’s type B drugs based on local medical needs, meaning they can add or delete a few and detail their own coverage rates for each drug.