Are imported brand-name drugs vanishing from China’s public hospitals?
China's latest healthcare system controversy: is it a rumor?
If you’ve been following China’s healthcare sector recently, you’ve likely heard about the uproar surrounding the 10th round of the country’s drug bulk procurement program, known as “集采”. This initiative, which has been running since 2019, is designed to control drug prices at affordable levels by leveraging the purchasing power of the state. But this latest round has sparked intense debate, with patients, doctors, and other experts questioning whether the program has gone too far.
The prices of many commonly used medications were slashed to jaw-dropping lows during this round, sparking widespread doubts among patients about their effectiveness and quality. Adding to the concern, nearly all the winning bids went to domestic manufacturers. With hospitals prioritizing the purchase of these lower-cost drugs, some patients have reported difficulties accessing imported, brand-name medications—even when they are willing to pay out-of-pocket. This has left many feeling frustrated and questioning whether they are being forced to compromise on the quality of their treatment.
What’s going on, and why is this such a big deal? Let’s break it down.
What is China’s drug bulk procurement program?
China’s drug bulk procurement program is essentially a centralized bidding system where the government negotiates directly with pharmaceutical companies to purchase drugs in bulk at significantly reduced prices. The goal is simple: to make essential medications more affordable for the public and to ease the financial burden on the country’s healthcare system.
This isn’t a new concept. Japan implemented a similar system years ago, and China has now completed ten rounds of bulk procurement since the program’s inception in 2019. Each round targets a specific list of drugs, from common medications for chronic conditions like hypertension and diabetes to more specialized treatments. The savings have been substantial—but while the program has been praised for making healthcare more accessible, the 10th round which closed in December 2024 has ignited a firestorm of criticism.
This round of the procurement has been referred to as the "largest ever" by the industry. It includes the highest number of products yet, with 778 products from 493 companies bidding. The price reductions are the steepest on record, with some products seeing discounts of over 90%. Drug prices have reached new lows, with enteric-coated aspirin dropping to just three cents per tablet. What’s most unexpected is that no original brand-name drugs were selected in this round.
After six years and ten rounds of bulk procurement, it’s become clear that original drugs are gradually being phased out of public hospitals. Some patients who previously preferred brand-name drugs are changing their healthcare habits, and pharmaceutical companies are now turning to the outpatient market to seek new sales opportunities. [sina finance]
Why has the 10th round sparked such a backlash?
The most striking feature of this round is the sheer scale of price reductions. For example, some drugs saw their prices drop by more than 90%. While this sounds like a win for patients, it has raised concerns about whether such steep cuts compromise drug quality and efficacy. Can a drug that costs 5% of its original price really be as effective? This question has left many patients uneasy.
On Chinese social media platforms, patients have been vocal about their experiences with bulk-procured drugs. Many claim that the drugs—often domestically produced generics—are less effective or come with more side effects compared to the original, often imported, versions. Some patients report needing to spend more money out-of-pocket to buy non-bulk-procured drugs from pharmacies to achieve the desired results. This has led to frustration: while prices are lower, the overall cost of treatment may not be.
In some regions, patients have reported difficulty accessing imported, brand-name drugs—even if they’re willing to pay for them out-of-pocket. Hospitals, under pressure to meet bulk procurement quotas, are prioritizing the cheaper, domestically produced alternatives. This has left some patients feeling they’ve lost the right to choose their preferred medications.
While there's no official data comparing the efficacy of bulk-procured generics versus their brand-name counterparts yet, the controversy nevertheless reached a boiling point when respected medical professionals began speaking out.
For instance, Zheng Minhua, a prominent surgeon from a reputable hospital in Shanghai and member of the Shanghai Municipal Committee of the Chinese People’s Political Consultative Conference, publicly criticized the program, citing issues like “blood pressure not dropping, anesthesia not working, and laxatives not having an effect.”
Like Dr. Zheng, several other whistleblower doctors from prominent hospitals across China have also come forward. Such statements from within the medical community have added fuel to the fire.
