AbbVie, Novartis and more win national coverage in China even as Pfizer's Paxlovid gets left out

Once again, biopharma companies offered hefty discounts to secure national reimbursement in China in the hopes that wider coverage in a fast-growing pharmaceutical market can offset price concessions. This time around, some companies are walking away with more deals than others.

In one of the largest drug price negotiations in China in recent years, 111 innovative drugs scored spots on the country’s National Reimbursement Drug List (NRDL) for the first time after offering an average of 60.1% discount, China’s National Healthcare Security Administration said (Chinese) Wednesday.

AbbVie’s inflammatory disease drug Rinvoq, Bristol Myers Squibb’s anemia therapy Reblozyl, multiple sclerosis meds from Biogen and Novartis, Roche’s oral spinal muscular atrophy treatment Evrysdi and Takeda’s next-generation hereditary angioedema treatment Takhzyro are among those 111 new entrants. But some other closely watched products, including Pfizer’s COVID-19 oral antiviral Paxlovid, walked away without a deal with the Chinese government.

Before the release of the full list, China’s medical expenditure watchdog already announced (Chinese) on Jan. 8 that Paxlovid didn’t get into the national healthcare insurance scheme because Pfizer’s price was too high. The med currently enjoys temporary nationwide coverage, which will expire with March.

The Pfizer antiviral has been in high demand since China relaxed its anti-COVID measures. Pfizer previously lowered the price to 1,890 Chinese yuan ($280) per box—which contains five days of treatment—from 2,300 yuan. But because of limited supply, Chinese people have reportedly been obtaining the drug—and purported generics—from the black market at prices as high as 50,000 yuan.

The fact that some patients are willing to pay high prices for Paxlovid suggests that Pfizer likely won’t be shaken by losing out on national coverage. During the J.P. Morgan Healthcare Conference last week, Pfizer CEO Albert Bourla, Ph.D., said its local contractor Zhejiang Huahai Pharmaceutical is expected to start making Paxlovid locally in China in the first half of this year.

Adding Huahai’s capacity could potentially ease Paxlvoid supply constraints. Market watchers will have a better idea of the size of China’s private pay COVID market by then.

Meanwhile, domestic drugmakers have started to throw their hats in the anti-COVID ring. While Paxlovid is being left out of national reimbursement, a traditional Chinese medicine and local drugmaker Genuine Biotech’s azvudine made it onto the NRDL.

To score a spot, Genuine cut azvudine’s price by 35.3% to 11.58 yuan ($1.72) per 3-mg tablet, according to the company. The drug’s discussed indication is actually HIV, but its COVID use—recommended dosage at five 1-mg tablets per day for no more than 14 days—will also be covered, according to local media reports.

Pfizer didn’t return empty-handed, though. The New York pharma won coverage for Ibrance in first-line HR-positive, HER2-negative breast cancer after years without national reimbursement—and after Eli Lilly’s rival drug Verzenio last year became the first CDK4/6 inhibitor to land national coverage. Pfizer’s two newer drugs, third-generation ALK inhibitor Lorbrena and JAK inhibitor Cibinqo, also earned spots on the NRDL.

Beyond COVID, neuroscience is seeing increased competition among multinational pharma companies. In multiple sclerosis, Biogen’s Tecfidera and Novartis’ Kesimpta both won NRDL listings.

After Biogen’s Spinraza made history last year as the first high-value rare disease drug included in the NRDL, Roche has quickly followed suit this year by securing coverage for rival drug Evrysdi. According to China’s state-run CCTV, Evrysdi struck a deal at 3,780 yuan ($560) per bottle, about 94% lower than the 63,800 yuan ($9,500) price tag when it entered the Chinese market last year.

Elsewhere, AbbVie took home first-time agreements for its JAK inhibitor Rinvoq and BCL-2 leukemia drug Venclexta. Rinvoq has become a key growth driver at AbbVie as the Illinois pharma braces for U.S. biosimilars to Humira.

In the cutthroat PD-1/L1 cancer immunotherapy battle, Big Pharma companies Merck & Co., Bristol Myers Squibb, Roche and AstraZeneca this time simply didn’t engage in pricing talks, despite being eligible. These foreign PD-1/L1 inhibitors have seemingly become comfortable with their market positions now years into their initial Chinese approvals.

Other existing PD-1/L1 players in China, such as BeiGene, Junshi Biosciences, a partnership between Eli Lilly and Innovent Biologics, and Jiangsu Hengrui Pharma expanded their offerings’ covered indications this time around. And in a setback for Fosun Pharma’s Henlius Biotech, the company failed to secure coverage for its PD-1 inhibitor serplulimab.