Some investors are concerned about China’s vigorous efforts to reduce medicine costs. Take AstraZeneca, the largest multinational pharmaceutical company in China, which anticipates a mid-single-digit percent fall in revenue in 2022. However, one set of analysts claims that the good times aren’t over yet. Despite pricing challenges, Jefferies analysts have projected that global biopharma companies will continue to grow strongly in China. According to Jefferies, China’s branded pharmaceutical market grew by 19 percent YoY to $31 billion in 2021. As per the analysts, the Chinese industry might develop at a 12 percent compound annual growth rate in the next few years, reaching $85 billion in 2030, ranking third behind the United States and the 5 biggest European nations combined.
The country’s national reimbursement drug list (NRDL), an ambitious price-cutting system that grants novel therapies nationwide coverage, has raised concerns about the Chinese pharma market’s long-term viability. In the most recent round of price negotiations, which ended in December 2021, 67 medications were added to the list for the first time, with an average reduction of 61.7 percent. Existing medications received price reductions as well, whether for a broader label or just renewal. The NRDL programme resulted in more aggressive price decreases, but access to innovative medicines in China remained limited, as per Jefferies. According to the analysts, only half of the new drugs licenced in developed nations are accessible in China, where there is a lot of flight still remaining.
As per the team at Jefferies, a product’s sales typically increase by 111 percent on average in the year after its admission to the NRDL. Relisting, on the other hand, can result in substantially slower growth, even just a drop. It is also worth noting that medications are being added to the NRDL considerably more rapidly these days, frequently within a year of approval. For example, Tyvyt, a PD-1 inhibitor developed by Innovent Biologics & Eli Lilly, received an NRDL place in 2020 with a 64 percent price reduction.
Huge income jumps after inclusion in the NRDL programme could be the consequence of an acceleration which would have taken considerably longer otherwise. And the lack of considerable growth after NRDL renewal—specifically, a period of time after the initial launch frenzy—raises concerns about the NRDL’s impact on a drug’s long-term growth potential.
One company which serves as the best example is AstraZeneca. The British manufacturer is the biggest foreign pharma company in China, with revenues of $6 billion in 2021. The company originally experienced double-digit revenue growth, partly thanks to the NRDL listing of its leading product, Tagrisso, an EGFR lung cancer drug. Despite a 71 percent price drop, Tagrisso’s sales increased nearly tenfold after its initial placement on the NRDL in 2019, according to Jefferies.
However, the drug’s pace has slowed at least temporarily since its inclusion in the front-line therapy setting and extension for the second-line indications in March 2021. When the Tagrisso slowdown was combined with pressure for the asthma medicine Pulmicort, AZ’s China division saw an unusual 9 percent revenue decline in the fourth quarter of last year.
AZ’s oncology chief, Dave Fredrickson, told investors during a teleconference in February that Tagrisso’s volume growth had already been able to cover the price cut after the NRDL expansion. AZ executives have warned that revenue increases via Tagrisso as well as other NRDL-covered releases will not be adequate to offset generic competition for earlier medications in China this year.
During the call, Leon Wang, AZ’s China and developing countries chief, said of the NRDL placement that the volume uptake truly takes time and that he still expects China will be a mono-growth case over the next five years. On the plus side, China’s budget appears to make more room for pharmaceuticals. According to Jefferies, China’s healthcare spending as a percentage of GDP was 7.1 percent in 2020, compared to 19.7 percent in the United States.
Apart from concerns about off-patent medicines, Big Pharma officials have expressed optimism about their innovative drug business in China. Last year, Novartis increased its sales in China by 10%, to $2.8 billion in constant currencies. As it reaps the benefits of NRDL listings for heart medicine Entresto plus anti-inflammatory biologic Cosentyx and also develops new therapies, the Swiss pharma is aiming for over $4 billion in sales in China by 2025.
The one thing he will say about China is that, looking forward and considering the fact that it is now so open to ideas, they are now contemplating China as they contemplate any other country, says Novartis Pharmaceuticals President Marie-France Tshudin during one of the conference calls.
