Analysis of nationwide availability of negotiated drugs in China’s National Reimbursement Drug List

TL;DR

This study finds that negotiated drugs in China's reimbursement list are poorly available, especially in pharmacies and lower-level hospitals, with significant regional differences.

Contribution

The study provides the first nationwide assessment of negotiated drug availability in China using a standardized framework and identifies key socioeconomic and policy factors influencing availability.

Findings

Mean availability rates of negotiated drugs were 2.08% in healthcare institutions and 0.13% in retail pharmacies.

Eastern regions and tertiary hospitals showed higher drug availability compared to other regions and lower-level institutions.

Drug availability correlated strongly with factors like regional GDP, health insurance fund balances, and policy releases.

Abstract

This study aims to evaluate the availability of Price-Negotiated Drugs under China’s National Reimbursement Drug List in healthcare institutions and designated retail pharmacies.

This cross-sectional study uses data from the National Health Insurance Service Platform (extracted in September 2025) to evaluate the availability of 383 National Negotiated Drugs in healthcare institutions and retail pharmacies nationwide. According to the World Health Organization (WHO)/Health Action International (HAI) framework, availability was assessed based on the availability rate and allocation rate. Spearman’s rank correlation test (α = 0.05) was applied to examine associations between drug availability and factors including the timing of formulary inclusion, per capita disposable income, regional gross domestic product (GDP), the number of relevant policy releases and Pharmacists, the accumulated balance of health insurance funds, and the average annual number of visits per person.

The overall availability of negotiated drugs was low, with mean availability rates of 2.08% in healthcare institutions and 0.13% in designated retail pharmacies. Although drugs were predominantly concentrated in tertiary hospitals, their average availability there remained modest at 9.84%. Substantial provincial disparities were observed in the allocation of tertiary hospitals, with the eastern regions showing relatively higher rates. Drugs added to the formulary earlier and those with higher clinical demand were more available. Spearman’s correlation analysis indicated significant associations between drug availability and timing of formulary inclusion (r = −0.53, p < 0.001), per capita disposable income (r = 0.45, p = 0.012), regional GDP (r = 0.49, p = 0.005), the number of relevant policy releases (r = 0.57, p < 0.001), the number of Pharmacists (r = 0.43, p = 0.017), the accumulated balance of health insurance funds (r = 0.61, p < 0.001), and the average annual number of visits per person (r = 0.62, p < 0.001).

According to the WHO/HAI standards, the overall availability of negotiated drugs in China remains relatively low, with notable institutional stratification and regional disparities. This finding suggests that policy efforts should focus on strengthening supply incentives and promoting rational drug use. Additionally, policymakers should consider the differences across regions and institutions when advancing drug availability to ensure equitable access to medicines.

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