Recently, a video of a Chinese elderly woman exposing the dark side of the CCP's healthcare insurance system has gone viral online. (Video screenshot)
[People News] The Chinese National Medical Insurance Administration (NMIA) announced that the 2024 National Drug Catalogue will officially take effect on January 1, 2025. This year marked the 10th batch of national centralized drug procurement, covering 62 drugs—all off-patent medications with multiple domestic generic versions available. A total of 234 companies and 385 products secured preliminary selection in this batch, with all selected drugs passing quality and efficacy consistency evaluations, ensuring high quality. Notably, no original research drugs were included in this year’s centralized procurement.
Patented drugs are those first submitted for patent protection globally, typically enjoying 20 years of exclusivity, during which no other company may produce generic versions. Original research drugs are those manufactured by the original producer after the patent period expires. Generic drugs are copies produced by other companies once the patent protection period ends.
Jin Chunlin, director of the Shanghai Health Development Research Center, highlighted two major characteristics of the selected drugs in the 10th batch: significant price reductions and a dominance of domestically-produced generics.
How Much Have Prices Dropped? The price cuts in this year’s procurement were astonishing. Of the 62 drugs included, over 50 experienced price reductions exceeding 90%. Some drugs reached unit prices as low as under 1 RMB.
Public data reveals that the average price reduction in the previous nine procurement rounds exceeded 50%. Except for the seventh batch (48%), the average reduction across the other eight batches ranged from 52% to 59%. However, the 10th batch saw unprecedented price drops, with 80% of the drugs reduced by more than 90%. For instance: Terbutaline sulfate injection dropped over 96%. Linagliptin tablets, neostigmine methylsulfate injection, norepinephrine bitartrate injection, and macitentan tablets dropped over 94%. Examples of final prices include: Folic acid tablets for less than 0.03 RMB per pill. Aspirin enteric-coated tablets for less than 0.05 RMB per pill. Potassium chloride injection for just 0.16 RMB per vial.
As a result, original research drugs have entirely withdrawn from this year’s catalogue. In a press briefing this April, an NMIA representative noted that in the five years since centralized drug procurement began, domestically-produced generics accounted for 96% of the selected drugs across the first nine batches. Before the 2018 launch of national procurement, the ratio of original research drugs to domestic generics was 1:1.
China’s widespread adoption of domestically produced generic drugs and their dramatic price reductions raise questions: is this a blessing or a curse? Here’s what netizens are saying:
“It’s all domestic generics—poor efficacy and severe side effects! This procurement process blocks imported original drugs from insurance coverage. Even paying out of pocket for imported drugs might soon be impossible.”
“This latest batch of insured drugs has left generic drug companies with no profit margins. What does that mean for the quality of next year’s Class A insured drugs? You can imagine.”
“The new insurance trick: vital medicines are removed, and it’s beyond imagination...”
Netizens’ concerns are not unfounded. Domestic generic drugs often fail to match the quality and efficacy of original drugs, with countless examples illustrating this disparity.
One social media user recounted their friend’s childbirth experience: the first delivery was painless, but during the second, despite receiving multiple doses of anesthetic, the pain was intense. The friend vividly felt the doctor working inside her abdomen, leading the user to suspect that the anesthetics have changed over the years.
A doctor shared:"Performing surgeries recently has been excruciating. Patients often wake up mid-surgery and move around. Anesthesiologists complain that since switching to generic anesthetics from the procurement program, this happens all the time. But you can’t just increase the dosage infinitely; guidelines strictly regulate usage. If you exceed the dose and something happens, you’re liable. We joke that we’ll need to rewrite textbooks just to accommodate these procurement drugs.”
A September 4, 2024, article in the Economic Observer reported a case of a child hospitalized for mycoplasma pneumonia. The hospital could only administer a domestic azithromycin, but after two days of IV therapy, the child’s fever persisted. The child was transferred to another hospital, where an imported original drug—Pfizer’s Zithromax—was used. The fever quickly subsided. The child’s father questioned why imported drugs that were previously available are now off-limits.
Another healthcare worker noted that when his mother had a lung infection, he tried to obtain imported moxifloxacin but found that the hospital only stocked domestic versions. He asked about the efficacy difference and was told the imported version was clearly superior but unavailable. Ironically, the price difference was minimal—imported moxifloxacin costs just a bit more than the domestic version but is far more effective.
A patient with hepatitis B who had been taking Vemlidy (tenofovir alafenamide) switched to a domestic generic but developed drug resistance within a year, along with kidney stones. The hospital refused to prescribe the imported drug, forcing the patient to buy it at full cost from a pharmacy.
Many netizens have shared their experiences with Bayer’s Adalat, a highly effective hypertension treatment. Some reported that when switching from the original drug to a domestic generic, they not only experienced headaches but also faced unstable blood pressure that fluctuated throughout the day. Switching back to Bayer’s original drug stabilized their blood pressure and eliminated the headaches. One individual noted that when the original drug was out of stock, they had to switch to a generic. Within less than a week, their blood pressure skyrocketed to consistently over 160 mmHg. To manage this, they had to add another antihypertensive medication. Even after returning to the original drug, their blood pressure never returned to its previous stable levels. The person clarified, “It’s not that I insist on using imported drugs; I just don’t have a choice.”
Among the most heavily procured drugs this year was aspirin enteric-coated tablets. Before the centralized procurement, the original drug’s price was already affordable—0.50 RMB per pill—while the domestic generic cost 0.30 RMB per pill. However, the winning bid brought the price of the generic down to an astonishing 0.03 RMB per pill. A 60-pill pack now costs only 2 RMB. Whether such a low-cost generic is effective remains uncertain. As one netizen put it, “Only after trying it will we know if it works.”
The most competitive drug in this year’s procurement was isosorbide dinitrate injections. Its packaging includes borosilicate glass vials, rubber stoppers, labels, small and large packaging, and excipient and raw material costs. Added to these are expenses for facilities, equipment, utilities, and R&D amortization. Given these cost factors, many are skeptical about how manufacturers are breaking even. The highest bid price was only 0.58 RMB per unit, while the lowest was a mere 0.22 RMB. This raises a critical question: “Is this about selling medicine or just selling the packaging?”
When people go to the hospital for treatment and medicine, their primary concern is efficacy and safety. Cost-saving should be built on this foundation. Without guaranteed efficacy and safety, what good is saving money? Even if the medicine is free, it would still be undesirable. This is common sense even a schoolchild understands. So, do the leaders and experts at the National Healthcare Security Administration (NHSA) truly not grasp this principle?
Since the NHSA introduced its "soul-bargaining" approach to centralized procurement, the resulting situation has turned into a paradox. Patients using health insurance are often limited to generic drugs. For chronic illnesses, these drugs may keep you alive, but the side effects and reduced effectiveness make long-term use increasingly unbearable. In the end, many patients are forced to pay out of pocket for original branded drugs, leaving their health insurance practically useless. Not only do they end up spending more, but they also endure greater suffering.
Meanwhile, officials at various levels boast about the rules they’ve established, which have forced pharmaceutical companies into relentless price wars. These measures not only boost the officials’ career performance metrics but also save money for the healthcare system—achieving multiple objectives at once.
But can manufacturers who bid low prices to enter the national reimbursement list sustain losses indefinitely? Isn't a decline in product quality inevitable sooner or later? The ultimate result is that people lose trust in domestically produced generics, opting to pay for branded drugs themselves. Health insurance costs are reduced even further—a double victory for the system. When viewed this way, it almost seems intentional.
(First published by People News)
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