METHODS: NRDL listings (2017–2021) were identified and key information extracted (31-Dec-2021).

RESULTS: The total number of medicines included in the NRDL increased by 11%, from 2571(2017) to 2860(2021). An average of 161 new medicines were added per year (range: 74[2021]–375[2017]), 51% of which were ‘Western’ medicines (i.e. non-traditional Chinese medicines). Negotiation success rates for new medicines was 77% (range: 59%[2019]–94%[2018]). However, the average price cut negotiated was 55% and has risen from 44% in 2017 to 62% in 2021. Further, the proportion of negotiated medicines developed by multinational manufacturers dropped from 61% in 2017 to 43% in 2021.

CONCLUSIONS: Since 2017, the NRDL has provided a route for public reimbursement of innovative patented drugs in the very large market represented by China. However, the trends over time are for increasingly steeper price cuts being demanded alongside an increasing focus on domestically-manufactured medicines. Pursuing NRDL public reimbursement poses significant questions for multi-national pharmaceutical companies in terms of the discounts required, volume/revenue potential, and launch sequencing considerations. To optimize access to the Chinese market, manufacturers should closely monitor evolving NRDL trends and the domestic landscape, validate price-access trade-offs, and be prepared with a tailored negotiation strategy.