The work a pharmaceutical CMO in China now has to do well

An innovative medicine launched in China now usually spends its first year or so as a self-pay product and then, if the company chooses and the negotiation succeeds, joins China's national reimbursement drug list at a substantially lower price. I plan a launch around that sequence instead of hoping to outrun it. For our IL-17A antibody I recommended a list price that left room for negotiation without being designed only for it, limited the self-pay launch to 110 specialist centres, and supported a means-tested assistance programme run by an independent charitable foundation. Inside Tanqiao I prepare the negotiation with health-economics, medical and finance colleagues: the budget-impact model, the comparison with treatments already reimbursed, and the walk-away price the board authorises in advance. The listing took effect in January 2025 at a payment standard 57 per cent below our launch list price. From then on, the work was about volume and access rather than price.

Reimbursement does not put a medicine on a hospital's shelves. Each hospital decides through its own pharmacy and therapeutics committee, which may meet only a few times a year and often limits how many new medicines it admits. Policy has tried to ease that path for negotiated medicines, including the dual-channel arrangement under which patients can collect some of them, with reimbursement, from designated pharmacies. My market-access team tracks every application, committee date and outcome by hospital, and prepares an evidence file for each committee rather than a promotional pack. Our antibody went from 110 hospitals in 2024 to 640 at the end of 2025 and 1,140 by June 2026, alongside 380 designated pharmacies with cold-chain storage and trained staff. I learnt the pharmacy side at Shuiyun Health, where a licensed pharmacist reviewed every online prescription before anything was dispatched.

I separate three activities the industry used to blur. Promotion belongs to marketing and must be accurate and balanced. Scientific exchange belongs to medical affairs. Continuing medical education should be independent of us even when we fund it. At Tanqiao that meant ending marketing's sponsored department meetings in July 2023, moving RMB 230 million of the remaining budget to medical affairs, and funding an accredited online curriculum through the Yuequan Dermatology Teaching Society, which chooses its own faculty and content. Speaker fees follow published bands, and no speaker receives more than ten paid engagements from us a year. Our specialist representatives now carry fewer materials and more knowledge: each passes an assessment on the disease, the trial data and the limits of permitted claims before visiting a hospital. Every paid engagement is entered in a register that our Audit Committee reviews twice a year.

Biologics for chronic inflammatory disease fail quietly when patients stop. The causes are familiar: fear of injecting, a skin infection that frightens someone into stopping, a refill missed during a move, a co-payment that arrives at the wrong moment. Our programme, run by Anxu Care Services, offers injection training, a nurse line, refill reminders and help with reimbursement at designated pharmacies. Under China's Personal Information Protection Law, health information is sensitive personal information and needs a patient's separate consent; we ask for it in plain language and collect only what the nurses need. Tanqiao receives aggregated reports by province, and representatives have no access to identifiable data or to which doctors' patients are enrolled. By June 2026 the programme had supported 23,400 patients at a cost of about RMB 48 million a year, and its design is audited by our compliance committee.

When a molecule enters volume-based procurement, the winning bidders receive a committed share of public-hospital volume at a price usually far below the old one, and the losers largely leave the public-hospital market for that molecule. Either way, most of the reason to promote it to doctors disappears. Since 2021 I have treated each procurement outcome as a marketing decision point. We stopped promotional spending on seventeen molecules Tanqiao won and redirected RMB 190 million towards the specialist launch and towards retail pharmacies for a few off-patent brands where patients still choose. For molecules we lost, we decided product by product whether private hospitals and pharmacies justified continued support, and withdrew from most. Generics still earn RMB 4.92 billion of our revenue. The marketing budget behind them is now a small fraction of what it was in 2019, and the people it once paid for now work on supply and service.

Every promotional claim at Tanqiao has an owner, a source and a medical reviewer, and the review happens at the brief rather than at the artwork. Chinese law confines advertising of prescription medicines to professional medical publications, so our audience for efficacy claims is clinicians. I insist that our materials report our own trial against its own comparator, with the patients who did not respond as well as those who did, and I do not allow cross-trial comparisons presented as superiority. For our antibody that means stating that 76 per cent of patients reached PASI 90 at week 12 in the pivotal trial, that about one in nine did not reach PASI 75, and what the common adverse events were. Patient-facing material is unbranded disease education, reviewed by medical affairs before publication. I would rather lose a detailing argument than win it with a chart a dermatologist could take apart.