Category C Drug List in China: New Commercial Insurance Channel for Innovative Drugs

The Category C drug list, scheduled for implementation in September 2025, introduces a new payment mechanism through commercial health insurance for innovative drugs not currently covered by China's basic medical insurance, as reported by a recent article by the Pharmaceutical Economic News Issue 6, 2025. The new framework is expected to support the commercialization of clinically needed, high-value therapies, while requiring coordination with domestic insurers on pricing and reimbursement strategies. Overseas companies should evaluate how this policy shift may affect their product pipeline and engagement with the Chinese healthcare system.

Definition and Characteristics of the Category C Drug List

The Category C drug list is a drug list guided by the National Medical Healthcare Administration and connected to commercial health insurance, not the traditional medical insurance payment system. Its launch aims to solve the payment dilemma for innovative drugs and provide a new payment channel for high-value innovative drugs.

Coverage: The Category C list covers drugs that are urgently needed clinically, innovative, but have high prices, especially those not included in the NRDL (National Reimbursement Drug List).
Payment Mechanism: Funded by commercial health insurance, requiring collaboration between drug companies and insurers to explore new payment models.
Implementation Timeline: Expected to launch in September 2025, aligning with annual medical insurance drug list adjustments.

Positioning of the Category C List in China's Medical Security System

Comparison with Medical Insurance List: Focuses on innovative and high-value drugs, unlike the basic drugs covered by the medical insurance list (Categories A and B).
Role of Commercial Insurance: Offers flexible payment options for innovative drugs, encouraging deep integration between commercial insurance and the pharmaceutical industry.
Policy Support: The National Healthcare Security Administration will synchronize Category C list adjustments with medical insurance list updates, reflecting government support for innovative drug payments.

Key Points for Overseas Manufacturers

Market Access for Innovative Drugs: The new payment channel for innovative drugs requires collaboration with insurers to explore volume-for-price models.
Pricing and Negotiation: Given limited commercial insurance payment capacity, drug companies may need to accept price reductions for greater market penetration.
Customized Strategy: To better meet China's unique market demands, overseas manufacturers should develop customized strategies.

Recommendations for Overseas Manufacturers

Collaborate with Commercial Insurers: Develop innovative payment models to increase market penetration.
Optimize Pricing Strategy: Balance accessibility and profitability in price negotiations.
Monitor Policy Developments: Work with consultant companies and stay informed about implementation details to adjust market strategies accordingly.

Further Information

To read the original pharmaceutical economics news regarding new payment mechanism through commercial health insurance for innovative drugs that are not currently covered by China’s basic medical insurance, please click here.

If you are a pharmaceutical manufacturer with questions about how the Category C drug list may affect access or reimbursement for your product in the China market, please contact Cisema.