A reimbursed price opens the hospital gate; it does not walk patients through it

Every year the negotiations for China's national reimbursement drug list produce a familiar set of headlines. A medicine has been added; its price has fallen by more than half; patients who could not afford it will now pay a fraction. Inside the company that negotiated there is relief, and often a celebration. I have been part of one. I have also learnt that, for a specialist medicine, the day a new list takes effect is closer to the start of a launch than to its end.

Our IL-17A antibody for psoriasis was listed from January 2025 at a payment standard 57 per cent below its launch list price. In 2024, as a self-pay medicine, it earned RMB 186 million in 110 hospitals. In 2025 it earned RMB 860 million, and by June 2026 it was stocked by 1,140 hospitals and 380 designated pharmacies. Those numbers suggest a smooth climb. It was not smooth, and almost none of the difficulty concerned price.

The year after the negotiation

Reimbursement makes a medicine payable. It does not make it available. Each hospital decides for itself which medicines it stocks, usually through a pharmacy and therapeutics committee that meets a few times a year, weighs budgets and the share of drug spending in hospital income, and may cap how many new products it admits. Policy has repeatedly tried to ease access for negotiated medicines, and the dual-channel arrangement, under which patients can obtain some of them with reimbursement from designated pharmacies, has helped. Even so, in our first reimbursed year the gap between hospitals that could have prescribed our antibody and hospitals that actually stocked it was the largest single constraint on patients receiving it.

That changes what marketing should spend money on. Before listing, most launch budgets go into awareness: congresses, materials and a large field force. After listing the work becomes specific and slow. Each hospital needs an evidence file prepared for its committee, setting out the trial data, the safety profile, the budget impact for that hospital and the patients already waiting. Each designated pharmacy needs cold-chain storage, staff who understand the reimbursement rules and a way for patients to find it. My market-access team tracks every application, every committee date and every outcome, hospital by hospital. It is the least glamorous work in my function and the most valuable.

I would argue that a specialist launch in China should weight its budget towards the eighteen months after listing rather than the months before it. We did this partly by design: we kept the self-pay launch to 110 centres and hired most of our specialist representatives only after the negotiation. We should have gone further and begun hospital applications in second-tier cities during the self-pay year, because committees there met so rarely that waiting cost us about a quarter.

What procurement taught our generics business

Tanqiao learnt the importance of access the hard way, through volume-based procurement. When procurement rounds began to cover our largest generic injectables in 2019, the winners received a committed share of public-hospital volume at prices often less than half of what they had been, and the losers largely lost the public-hospital market for that molecule. Our revenue fell from RMB 7.42 billion in 2019 to RMB 5.06 billion in 2022.

For marketing, procurement had a clarifying effect. A molecule we had won no longer needed promotion; a public process had decided its volume, and the remaining job was reliable supply. A molecule we had lost could rarely be rescued by promotion in public hospitals. We stopped promotional spending on seventeen won molecules and moved RMB 190 million towards the launch and towards a few brands that patients still choose in retail pharmacies. The lesson I carried into the biologic was that, once a public payer has set price and eligibility, the commercial question becomes whether the system actually delivers the medicine, not whether doctors have heard of it.

Spending where patients drop out

The second half of access is persistence. A biologic for a chronic inflammatory disease delivers value only if patients keep taking it, and in our self-pay year roughly half stopped within twelve months. Reimbursement removed some of the cost barrier but not the others: fear of injecting, a skin infection that frightened someone into stopping, a move to another city, or confusion about which pharmacy could dispense a reimbursed injection.

We built a support programme run by an independent nurse service, with separate patient consent for health information and no access for our sales force. Among the 23,400 patients enrolled by June 2026, twelve-month persistence was 63 per cent. Patients who choose support differ from those who do not, so I treat the comparison with non-enrolled patients as an indication rather than proof. The direction is clear enough to justify the RMB 48 million a year the programme costs.

If companies measured launches by patients still on treatment a year after listing, rather than by sales in the first reimbursed quarter, their budgets would move. Less would go into the weeks around the announcement, and more into committee files, pharmacy training and nurses who answer the telephone in the evening when a patient is unsure whether to inject.

The negotiation also changes how a company should talk about price. A medicine priced for reimbursement no longer needs a story about why it is worth its list price. It needs an account of why a hospital with a constrained budget should stock it and how a patient will keep taking it. Those are questions of evidence and service. They reward companies that have done the work, and they expose companies that spent their launch budgets on the announcement.

None of this is an argument against the negotiation, which has made specialist medicines affordable for very large numbers of patients. It is an argument for marketing leaders to stop treating the listing as the goal. The goal is a patient who started treatment, stayed on it and was well looked after. A reimbursed price is the condition for that, not the achievement.