IHS Global Insight Perspective | |
Significance | The long-awaited new Basic Health Insurance Formulary has been released in China with 2,151 medicines listed. There will be 503 drugs eligible for full funding of public health insurance and 1,648 drugs for partial reimbursement with patient co-payments. All 307 essential drugs have been included for full funding. |
Implications | This is China's first update of its basic health insurance formulary in five years after the release of its 2004 version. The classifications of drugs for full or partial funding have given essential drugs higher overall reimbursement rate than non-essential medicines. |
Outlook | Generic drugs have constituted a majority of the listed drugs, which will consequently threaten the market share and revenue of multinationals' innovative drugs in the Chinese market. In addition, the traditional Chinese medicine sector is also set for a boost encouraged by the high percentage of inclusion in the formulary. Innovative pharma companies may see the need to adjust their diversification strategy to address the changes in these two sectors in order to grow in China. |
China's Ministry of Human Resources and Social Security (MoHRSS) has issued its new Basic Health Insurance Formulary (BHIF), including a list of 2,151 drugs to be covered by the country's basic public health insurance, as part of the ongoing national healthcare reform. The formulary has included 1,164 chemical, biological "western" drugs and 987 traditional Chinese medicines (TCMs). In addition, the formulary also categorises listed medicines into two classes, Class A for full reimbursement without patient co-payments and Class B for partial insurance reimbursement with certain percentage of co-payments. Western drugs including 349 Class A medicines and 791 Class B medicines while 154 Class A and 833 Class B TCMs have been listed. The 307 drugs included in China's Essential Drug List earlier this year have all been listed in the Formulary under Class A. The Formulary can be found here on the MoHRSS website.
Compared to the country's old BHIF released in 2004, the 2009 version has demonstrated main changes including:
- All the drugs on the Essential Drug List have been included for full public insurance reimbursement under Class A;
- The number of drugs listed in the Formulary has increased by 260, representing a 13.7% rise to that in the 2004 version. There has also been an 11.8% increase in the number of Class A drugs;
- Some previously listed but not widely used medicines have been replaced by more commonly used products.
The Formulary has included chemical drugs under 22 therapeutic areas including oncology, respiratory, urology, mental health and immunology treatments. Some 86 anti-cancer treatments have been listed including docetaxel, cisplatin, and irinotecan. The mental health treatment category has included 57 drugs such as risperidone, diazepam and maprotilin. Tacrolimus is among the 18 medicines listed for immunology disease treatment.
The MoHRSS has requested the regional governments in China to start adopting the new Formulary's listing of Class A drugs from December. Class B drugs' inclusion allows a regional adjustment in the range of 15%, which is expected to be completed by next March.
Outlook and Implications
The issuance of the new BHIF is the first of its kind since 2004, and constitutes an import part of China's ongoing national healthcare reform by clarifying medicines to be fully or partially reimbursed by the country's public health insurance. In addition to the expansion of the drugs included, the new formulary has also made an improvement in terms of listing all 307 essential drugs under Class A for full insurance coverage. The listing has also covered a wide range of therapeutic areas, among which a wide variety of medicines have entered into oncology listing. IHS Global Insight last week reviewed the execution of the national healthcare reform plan at provincial levels (see China: 27 November 2009: Chinese Provinces Start Rolling Out Regional Essential Drug Systems Following Government Reform Guidelines), and is expecting to see a swamp of BHIF adjustments starting from this month to put the central government's guidelines into place.
As seen in the earlier-released Essential Drug List, the majority of the drugs included in the BHIF are widely-genericised products. It is not unexpected as cost containment has to come hand in hand with expanded coverage. It will therefore encourage the consumption of drugs listed in the formulary and bolster the sales of generic drug makers. On the other hand, it will consequently threaten the revenue and market share of innovative manufacturers in the Chinese market. In addition, the listing has also given considerable weight to TCMs, which account for some 46% of the total number of medicines included in the formulary. In order to enhance their strength and revenue in the fast-growing market of China, multinational pharma companies may need to look into partnership and acquisition opportunities in the country's generic and TCM sectors as part of their global business diversification strategies.