The sales of commercial insurance innovation drugs remain concentrated in public hospitals in a few provinces and cities such as Beijing and Shanghai.
It will soon be one month since the first edition of the commercial insurance innovation drug directory was implemented. Over 70% of the drugs listed in the directory are being sold at more than 200 designated healthcare institutions nationwide, with Alzheimer's disease treatments showing the highest sales penetration rate within the hospital market. However, compared to "National Negotiated Drugs," the sales of commercial insurance innovation drugs are still heavily concentrated in public hospitals within a limited number of provinces and municipalities like Beijing and Shanghai, with pharmacy sales accounting for a minimal share.
On the 21st, the National Healthcare Security Administration (NHSA) released the latest sales data for new drugs listed in the 2025 editions of the National Reimbursement Drug List (NRDL) and the Commercial Insurance Innovation Drug Directory across designated hospitals nationwide. The new versions of both the NRDL and the Commercial Insurance Innovation Drug Directory officially took effect on January 1st this year. The updated NRDL added 114 new drugs, while the Commercial Insurance Innovation Drug Directory incorporated 19 drugs. This statistical report covers the period from the implementation date up to January 20th. This marks the second disclosure by the NHSA regarding the implementation status of the "dual directories" within half a month.
Data from the NHSA shows that as of January 20th, 99 of the newly added NRDL drugs have been sold at 12,198 designated healthcare institutions, while 14 drugs from the Commercial Insurance Innovation Drug Directory have been sold at 223 designated institutions.
Although over 70% of the commercial insurance innovation drugs have sales records, the specific sales performance of these 14 drugs varies significantly.
Alzheimer's disease treatments are experiencing the fastest sales penetration within the hospital market. Among them, Lecanemab injection, primarily developed by the multinational pharmaceutical company Eisai, has been sold at 158 designated healthcare institutions. Donanemab injection, developed by another multinational firm Eli Lilly, also has sales records at 46 designated institutions.
This trend is likely related to the broader patient population eligible for these treatments. Relevant statistics indicate that in 2024, China had approximately 17 million patients with mild cognitive impairment (MCI) or mild dementia due to Alzheimer's disease, and this number is expected to continue rising with the aging population.
Several anti-cancer drugs are also accelerating their penetration into the hospital market. For instance, Ipilimumab injection, developed by Bristol Myers Squibb for treating malignant pleural mesothelioma, colorectal cancer, and hepatocellular carcinoma, has been sold at 35 designated institutions nationwide. Lurbinectedin for injection, used for treating adult patients with metastatic small cell lung cancer (SCLC), has also been prescribed at over 10 hospitals across the country.
Drugs for rare diseases are a key focus of coverage in the first edition of the Commercial Insurance Innovation Drug Directory. However, sales data within the hospital market remains relatively scarce. This is partly due to the inherently small and dispersed patient populations for rare disease treatments, and partly because prescriptions from doctors and patient medication usage are concentrated within the lead hospitals of regional rare disease diagnosis and treatment networks.
For example, Teduglutide for injection, developed by Takeda for treating short bowel syndrome, has only been sold at one designated pharmacy in Shenzhen so far this year.
Furthermore, five innovative drugs have not yet generated any sales at designated healthcare institutions nationwide after being included in the directory. This includes four CAR-T products with market prices ranging from 990,000 to 1.3 million RMB per infusion, namely Axicabtagene Ciloleucel injection, Naxiagene injection, Relmacabtagene autoleucel injection, and Equecabtagene autoleucel injection, as well as a domestic new drug, Velaglucerase alfa for injection, approved just last May for treating the rare disease Gaucher disease.
From an industry perspective, the temporary absence of hospital sales does not necessarily mean these drugs have not benefited from the directory's "hospital entry" support policies. The NHSA has committed to implementing a "Three Exclusions" policy for the directory, which essentially opens a pathway for high-cost self-pay drugs like CAR-T therapies and rare disease treatments to enter hospitals. However, the journey from "hospital entry" to actual "sales" involves additional steps like "doctor prescribing" and "patient payment." Factors such as small eligible patient populations for innovative drugs, physician hesitancy in using newly launched drugs, and the significant out-of-pocket costs remaining for commercially insured patients even after insurance payouts can all impact the final sales volume.
Regarding "hospital entry," most provincial healthcare security bureaus have now clarified that the process for the Commercial Insurance Innovation Drug Directory will follow the same pathway as "National Negotiated Drugs." Furthermore, according to a source from a tertiary public hospital in Shanghai, they recently received instructions from relevant authorities to include all 19 drugs from the first edition of the directory in the procurement list for their international medical department. This move is expected to address medication accessibility for purely commercially insured patients within the hospital setting. However, since the vast majority of commercially insured patients visiting hospitals are also basic medical insurance enrollees, payment mechanisms for this group, and how self-pay drug costs and overall medical expenses align with relevant medical insurance payment policies and hospital assessment criteria, still require clarification.
Based on the sales data for newly listed drugs in the "dual directories" disclosed by the NHSA, the sales of commercial insurance innovation drugs remain more concentrated in public hospitals within provinces like Beijing, Shanghai, Jiangsu, and Guangdong compared to "National Negotiated Drugs."
Additionally, in contrast to "National Negotiated Drugs," where designated retail pharmacies account for nearly half the sales, the aforementioned 14 commercial insurance innovation drugs are currently only sold at approximately 11 designated retail pharmacies nationwide, representing less than 10% of the 223 designated institutions with sales records.
The NHSA has proposed that "relevant regional pooling areas may explore supporting designated retail pharmacies in stocking drugs listed in the Commercial Insurance Innovation Drug Directory." However, according to analyses, only a few regions like Guangdong and Chongqing have explicitly stated, while implementing the directory, that they "support prescription流转 for commercial insurance innovation drugs" and promote "the stocking of these drugs by designated pharmacies."
Several industry experts recently interviewed highlighted that achieving significant sales volume for commercial insurance innovation drugs will still rely heavily on the out-of-hospital market. To further promote prescription流转 for these drugs, greater efforts are needed to strengthen the linkage between the Commercial Insurance Innovation Drug Directory and the medical insurance "Dual-Channel" policy. This would enhance policy confidence for designated hospitals in stocking these drugs, clarify access thresholds, and ensure medication safety.
