context: The extreme price cut in the previous tenth round of national drug procurement raised public concern over ineffective drugs and lack of access for imported original drugs. During Shanghai's 2025 Two Sessions, twenty members of the Chinese People's Political Consultative Conference jointly submitted a proposal on how to access effective medications with centralised drug procurement. The National Healthcare Security Administration responded on 19 January with a promised trip to Shanghai to gather in-person feedback.
The proposal notes
- unstable efficacy in certain procured drugs procured in clinical practice
- particularly for hypertension, diabetes, colonoscopy preparation laxatives and anaesthetics
- frequent reports of poor effectiveness, with some cases showing no improvement even with increased dosage
- doctors feel helpless in such situations, having neither alternative options nor channels to report these issues
The proposal was primarily authored by Zheng Minhua 郑民华 Shanghai Chinese People's Political Consultative Conference member and Ruijin Hospital General Surgery director. The co-signers include renowned doctors
- Zheng Junhua 郑军华 Renji Hospital Party Secretary
- Hu Weiguo 胡伟国 Ruijin Hospital Party Secretary and deputy director
- Li Xianhua 李贤华 Ruijin Hospital Outpatient office director
- Xu Hong 徐虹 Fudan University Children's Hospital Party Secretary
- Zhou Pinghong 周平红 Zhongshan Hospital Endoscopy Centre director
- Qian Juying 钱菊英 Zhongshan Hospital deputy director
- Mao Enqiang 毛恩强 Ruijin Hospital Emergency Department director
- Xu Jianmin 许剑民 Zhongshan Hospital Colorectal Surgery director
- Jiang Xinquan 蒋欣泉 Shanghai Jiao Tong University School of Stomatology executive dean
- Zhang Weihong 张伟宏 Shanghai Civil Affairs Second Mental Health Centre ward director
The proposal offers four key recommendations to maintain access to original drugs
- doctors should be allowed to specify original drugs in prescriptions
- special channels or supplementary insurance should be considered for complex conditions like rare diseases or cancer
- patients with sufficient financial means should be permitted to purchase original drugs through hospital pharmacies or licensed retailers, with different reimbursement rates for original versus generic medications
- the ratio restriction between original and generic drugs should be lifted, giving doctors more choice while ensuring quality original drugs are included in medical insurance coverage
Zheng explains these suggestions come from a clinical perspective. He proposes varying reimbursement rates. For example, 100 percent for procured generics, 70 percent for quality domestic drugs and 30 percent for original drugs, allowing patient choice with partial self-payment.
The proposal also recommends strengthening adverse drug reaction reporting systems. Zheng identifies several challenges with centralised procurement
- quality concerns affecting patient trust and treatment compliance
- limited drug selection impacting treatment options
- mismatches between procurement quotas and prescription management
- supply shortages affecting clinical needs
He suggests authorities balance regulation with flexibility and avoid purely price-driven competition. Healthcare institutions should combine clinical practice with research, providing training on procurement policies and rational drug use. They should establish monitoring systems for procurement drugs and conduct real-world studies on clinical efficacy and safety.
Zheng emphasises the importance of addressing public concerns through transparency in drug information and quality inspection results, while encouraging supplementary commercial insurance coverage.