HONG KONG – China's State Medical Insurance Administration has added 17 cancer drugs to the National Reimbursement Drug List (NRDL) covered by its national basic health insurance, work-related injury insurance and maternity insurance this week, slashing their prices as much as 74 percent. (See drug list, below.)

The move aims to render necessary drugs for fatal diseases affordable for most people in the country, as China is known for unreasonably high prices of cancer drugs. The administration's notice said the 17 drugs will be eligible until the end of November 2020.

"The expansion of the list will go some way to addressing the very real perception that China is a market of unaffordable cancer medication, so this development should be welcomed," Tim Gamble, head of pharma consulting at Economist Intelligence Unit Healthcare, told BioWorld. "The government is also urging physicians to prioritize the prescription of products on the list."

Among the approved 17 drugs, 11 entered the China market in 2017 or 2018. Fifteen are imported drugs, while the other two are Jiangsu Hengrui Medicine Co. Ltd.'s biosimilar pegaspargase (Oncaspar) targeting acute lymphoblastic leukemia (ALL), and Jiangsu Chia-Tai Tianqing Pharmaceutical Co. Ltd.'s anlotinib hydrochloride capsules targeting non-small-cell lung cancer. Hengrui's 5-ml and 2-ml injections of pegaspargase are priced at ¥2,980 (US$433) and ¥1,478 (US$215). Chia-Tai Tianqing's 12-mg anlotinib hydrochloride capsules are priced at ¥487 (US$71).

Novartis AG's 30-ml octreotide microsphere injection has the highest unit price of all the newly added drugs with a ¥7,911 (US$1,149) price tag.

The prices of those drugs were down by 27 percent to 74 percent – 56.7 percent on average – after the government went through rounds of discussions with the drug companies. The drug procurement departments in different provinces are required to list the products online on their centralized procurement platform. The regulators urge related departments to start following the new payment standards before the end of November.

Currently, China's basic medical insurance covers 1.35 billion people, accounting for 95 percent of the nation's population. The authorities scrapped the import tariffs on 103 of 138 cancer drugs available in May this year, as well as reducing the value-added tax levied on them. Out of the 103 drugs, 82 have been included in the national medical insurance system, according to the National Health Commission.

Before the drugs were approved, the public medical insurance covered mainly basic health care, leading to heavy financial burdens on families of cancer patients. China's box-office hit film "Dying to Survive" in July, depicting a leukemia patient smuggling cancer drugs from India for treatment, was said to reflect the plight in reality.

Not enough

Gamble said China emerges as one of the countries with the least affordable prices in the world.

"In 2017, the cost of a week's dosage of the generic version of a targeted therapy for lung cancer, gefitinib, exceeds $1,470," he said. "This is almost twice the average person's monthly disposable income in the country's richest provinces – Shanghai and Beijing."

Chinese biopharma Beigene Ltd. saw its Vidaza (azacitidine for injection) added to the list this time around. The drug was approved in China for treating intermediate-2/high-risk myelodysplastic syndrome (MDS), acute myeloid leukemia (AML) with 20 to 30 percent bone marrow blasts and chronic myelomonocyte leukemia (CMML).

"Vidaza became commercially available in China in February and is the only approved hypomethylating agent shown to prolong survival for patients with MDS. With this national reimbursement coverage, we expect more patients to have an opportunity to benefit from Vidaza in China," Xiaobin Wu, general manager of China and president of Beigene, told BioWorld.

Beigene said the negotiated price in China is ¥14,770 (US$2,132) for each treatment cycle of four weeks, after a price cut of 60 percent.

The company has recently filed NDAs in China for two cancer drugs: tislelizumab, a monoclonal antibody targeting solid tumors and hematologic cancers, and zanubrutinib, a molecule inhibitor of BTK for treating various lymphomas. Beigene expects to file an NDA in the U.S. for zanubrutinib in Waldenstrom macroglobulinemia, a type of non-Hodgkin lymphoma, in the first half of 2019.

Despite that 17 drugs were added on the reimbursement list, Gamble said it's not enough to solve the nation's issue of high medical bills.

"With the three public insurance schemes and shallow drug coverage, a significant proportion of drug expenditure remains out of pocket. Provinces are allowed to independently create supplement lists, so there is often a regional dimension to access," he said. "I don't think admission [of the 17 cancer drugs] to the reimbursement list automatically resolves access issues."

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