Implementation of Generics and Biosimilars: A Drug-Form-Level Sales-Volume Analysis of China’s National Reimbursement Drug List, 2020–2024
This study analyzes China's National Reimbursement Drug List from 2020 to 2024 to reveal that while generic and biosimilar sales volume has modestly increased overall, their implementation remains uneven with significant heterogeneity across drug forms and notably low uptake in sensory organ medicines, suggesting a need for a stratified policy approach targeting high-volume, low-uptake products.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Imagine the healthcare system as a giant, bustling marketplace where people buy the medicine they need to stay healthy. In this market, there are two main types of sellers for the same product: the "Original Brand" (the first company to invent a drug) and the "Generic" or "Biosimilar" (other companies that make a copy once the original's special patent expires). Think of the Original Brand like a famous, expensive designer sneaker, and the Generic as a high-quality, much cheaper version made by a different factory. Everyone hopes that when the cheaper version arrives, people will switch to it. This switch is super important because it saves the whole market (and the government's wallet) tons of money, making sure more people can afford their medicine. But here's the tricky part: just because the cheaper shoes are on the shelf doesn't mean everyone is actually buying them. Sometimes, people still stick with the expensive brand, or maybe the cheap ones never even make it to the shelf in the first place. Scientists want to know: Are the cheap copies actually replacing the expensive ones in real life, or is the switch just happening on paper?
This paper dives into that exact question, but specifically within China's National Reimbursement Drug List (NRDL) between 2020 and 2024. The NRDL is basically the government's "approved shopping list" of medicines that people can get reimbursed for. The researchers used a massive database of sales numbers to look at how much of the "cheap" medicine was being sold compared to the "original" medicine. They didn't just look at the total money spent; they looked at the actual number of units sold (like counting every single bottle or box). They focused on "drug forms," which is just a fancy way of saying a specific medicine in a specific size or shape (like "Ibuprofen 200mg tablets").
So, what did they find? It turns out the story is a bit messy. First, they discovered that for many medicines, the "cheap" version was the only one being sold, or the "original" was the only one. But for the medicines where both were available (which they called "comparable drug forms"), the switch wasn't happening everywhere equally. Out of 514 of these comparable medicines, the average amount of "cheap" medicine sold was about 64.5% in 2024, which is a small but steady increase from 60.0% in 2020. However, the big surprise was that this switch wasn't uniform.
The researchers found that the "Sensory Organ" medicines (think eye drops, ear drops, and things for your nose) were the biggest laggards. In this category, the cheap versions only made up about 27.4% of sales, which was significantly lower than in other areas. It's like if everyone in the city switched to the cheap sneakers, except for the people who needed running shoes for their eyes—they were still buying the expensive ones. Beyond that specific category, the problem was scattered. About 231 of the 514 medicines (that's nearly half!) still had less than 50% of their sales coming from the cheap versions. This means that even when both options were available, a huge chunk of people were still sticking with the original brand.
The study also checked if the type of insurance coverage (Class A vs. Class B) made a difference, but they found no clear pattern; the switch happened (or didn't happen) regardless of the class. They also looked at where people bought the medicine. The switch to cheaper versions was slowly growing in hospitals and online stores, but it wasn't really happening in retail pharmacies.
In short, the paper suggests that while China has set up the rules and the shelves to allow for cheaper medicines, the actual "switch" in people's shopping carts is uneven. It's not a total failure, but it's not a total success either. The authors conclude that we can't just look at the big picture; we need to zoom in on specific medicines and specific types of drugs (like those for the eyes and ears) to figure out why the switch is stalling there, so we can fix those specific bottlenecks.
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