Since the implementation of the Chinese Communist Party’s “National Drug Centralized Procurement” policy, the presence of imported drugs in the Chinese market has been gradually diminishing. From the cholesterol-lowering drug “Lipitor” to the blood pressure medication “Norvasc”, the once familiar original drugs are disappearing from hospital shelves. More and more patients are complaining that “good medicines are hard to buy”, and doctors also lament that their “treatment options are limited”.
In the first half of this year, the CCP initiated the tenth batch of centralized drug procurement, including a total of 435 types of drugs. The Medical Insurance Bureau stated in its announcement that the goal of centralized procurement is to “exchange quantity for price, so that patients can afford medication”. By the year 2025, a total of 10 batches of drugs have been included, with a significant average price reduction. For example, the commonly used diabetes drug Acarbose tablets dropped from 1.86 yuan per tablet before centralized procurement to 0.12 yuan per tablet, and some cancer drugs saw price reductions of over 70%.
An article on Netease on September 27th pointed out the mass exodus of imported drugs from China since the policy was implemented in 2018, signaling a quiet transformation in the Chinese pharmaceutical market. With the exit of actively traded imported drugs from the market vacuum, domestic generic drugs swiftly filled the gap. However, many multinational pharmaceutical companies ultimately chose to exit due to high R&D costs and limited room for price reductions.
The article cited an example from the 2024 drug procurement bidding where the multinational pharmaceutical company MSD abandoned three varieties. Their Voriconazole Injection and Voriconazole Enteric-coated Tablets were priced significantly higher than domestic generic drugs, leading to their exit from the Chinese market.
“We used to consider China as a core market, but now there is almost no profit margin,” a deputy manager of a foreign pharmaceutical company in Wuhan told Dajiyuan, “For the company, it’s just a matter of time before we exit. Currently, the company has fewer than 15 employees in China, with only 5 in Beijing and just 4 in Wuhan.”
According to public data from the CCP’s National Medical Products Administration, mainland China has about 170,000 drug approvals, with over 95% being generic drugs. With the accelerated aging of the population, demand is rising rapidly. The CCP’s seventh census revealed that the population aged 60 and above has reached 264 million, accounting for 18.7% of the total population. The National Health Commission disclosed that around seventy percent of the elderly population have one or more chronic diseases, indicating a significant patient group in need of long-term and stable drug supply.
Ms. Zhang, a resident of Weifang, Shandong, told Dajiyuan that her seventy-year-old mother has high cholesterol and had been taking imported “Lipitor” for over a decade but now struggles to get it. She mentioned, “The doctor says there are only domestic generic drugs available now. When my mother took it, she felt that the effect was not as stable as before. Imported drugs are expensive, and we can’t afford them.”
Ms. Zhang also mentioned that her friend faced a dilemma at the hospital after undergoing post-gastric cancer surgery when the supply of nutritional solutions was discontinued: “Previously, a bag of nutritional solution cost 260 yuan, although expensive, it was available. Now, despite the price reduction after centralized procurement, it’s completely unavailable due to the manufacturer’s complete withdrawal.”
In Jinan, Mr. Cao, a veteran, relied on imported Acarbose for his long-term diabetes. He told reporters, “The German original drug is out of stock, and the domestic drug causes significant gastrointestinal reactions, affecting my work. But the doctor said there is no other option.”
Acarbose is an alpha-glucosidase inhibitor used primarily in the treatment of type 2 diabetes. The drug entered the Chinese market in the 1990s, and was included in the catalog during the first round of centralized procurement in 2018, reducing the price from 1.86 yuan to 0.12 yuan per tablet, a reduction of over 85%. With the influx of Chinese generic manufacturers like Huadong Pharmaceutical, Chongqing Huabang Pharmaceutical, and CSPC Group, imported drugs from Germany gradually phased out of the market.
Ms. Liu in Beijing mentioned that her father had long relied on imported “Norvasc” for high blood pressure. She said, “Now that it’s out of stock, the doctor recommended a domestic generic drug. But after my father took it, he felt anxious, with fluctuating blood pressure, which worries our whole family.”
“Norvasc” (generic name: Amlodipine) is a calcium channel blocker primarily used in the treatment of high blood pressure and angina. Before centralized procurement, imported drug prices ranged from 3 to 4 yuan per tablet, while domestic generic drugs cost as little as a few cents. Doctors generally reflect that generic drugs pass bioequivalence tests but often lack the stability in clinical effectiveness compared to the original drugs, making it challenging for some patients to control their conditions.
Dr. Li from the Southern Hospital in Guangzhou told Dajiyuan, “Original drugs have undergone more than a decade of development with more comprehensive clinical verification. When we switch to generic drugs, how can the medication effects be exactly the same? Some patients are even willing to self-pay for imported drugs, but find that the channels are increasingly limited and the prices are higher than before.”
An investigation revealed that while the main contradiction for patients in the past was “medicine was expensive but available”, it has now turned into “cheap but out of stock”. The reduction in drug prices has not truly brought about a universal sense of security, but has instead plunged some individuals into new predicaments.
Mr. Liu, a retired professor from the School of Public Health at Peking University, pointed out, “The logic of centralized procurement is ‘benefiting the majority’, but the few patients relying on imported original drugs have become sacrificial pawns. This is the hidden cost in policy design.”
He further explained that the exit of imported drugs and the entry of domestic drugs have heightened the contradictions in healthcare reform. “The biggest problem facing countless patients is not ‘expensive drugs’, but ‘hard to find good medicines’. China has undergone numerous medical reforms, but often the more they change, the worse it gets. The fundamental reason is that these reforms touch upon massive interest groups.”