A recent study published in Frontiers in Pharmacology has examined the impact of China’s National Drug Price Negotiation (NDPN) policy on the characteristics, accessibility, and regional equity of pediatric medicines. The research, conducted by a team from West China School of Pharmacy, Sichuan University, highlights that while the policy has significantly improved the affordability of these crucial medications, notable challenges persist in ensuring widespread pediatric medicine access across healthcare institutions and regions.
Pediatric medicines present unique development and accessibility challenges globally due to dose sensitivity, specialized administration methods, and stringent applicability requirements. China, with a substantial child population, has increasingly focused on innovative pediatric medicine development, yet a review cited in the study indicated that nearly 90% of medications in China lack child-specific formulations.
Evaluating Pediatric Medicine Access and Affordability
The study systematically analysed the inclusion of pediatric medicines in China’s National Reimbursement Drug List (NRDL) through negotiation from 2017 to 2024. Researchers classified pediatric medicines into two categories:
- Co-use Medicines for Adults and Children (CMACs): Medications suitable for both adult and pediatric populations.
- Child-Specific Medicines (CSMs): Drugs exclusively formulated and indicated for pediatric use.
The assessment focused on availability, affordability, and regional equity, adapting methodologies from the World Health Organization (WHO) and Health Action International (HAI).
Inclusion and Formulations
Between 2017 and 2024, the NDPN policy led to the identification of 108 pediatric medicines. Of these:
- 83 medicines (76.85%) were CMACs.
- 79 medicines (73.15%) were Child-Appropriate Formulations (CAFs), which are dosage forms suitable for children, such as oral solutions, suspensions, or granules.
The study found that the average delay from market launch to inclusion in the NRDL for pediatric medicines was 4.40 years. This suggests an acceleration in the inclusion process, reflecting the policy’s prioritisation of pediatric health.
Availability Challenges Persist
Despite improvements in inclusion, significant gaps in availability were observed. The Drug Availability Rate (DAR) and Drug Provision Rate (DPR) for pediatric medicines in early 2025 were 7.89% and 8.71% respectively in tertiary medical institutions. These rates were notably higher than those in secondary and lower-level institutions, indicating a disparity in access across different levels of healthcare facilities. This suggests persistent “last-mile” barriers in ensuring that these medicines reach all points of care.
Improvements in Affordability
The NDPN policy demonstrated a positive impact on affordability. The average Defined Daily Dose cost (DDDc) for CSMs was lower than for CMACs. Crucially, reimbursement through the NRDL increased the number of affordable pediatric medicines from 85 (78.70%) to 104 (96.30%). This indicates that the negotiation strategy successfully reduced the financial burden on households, making a wider range of essential pediatric treatments accessible financially.
Regional Equity and Policy Implications
The study also assessed regional equity, finding that after accounting for population factors, the distribution of pediatric medicine varieties across provinces was relatively balanced, with the Gini coefficient below 0.4. This suggests that the policy has contributed to a more equitable distribution of available medicines at a broader regional level, though institutional-level disparities remain.
The researchers concluded that while China’s NDPN policy has been effective in improving affordability and accelerating the inclusion of pediatric medicines, critical gaps remain in the availability of Child-Appropriate Formulations and consistent access across various healthcare institutions and regions. These findings provide valuable evidence to support ongoing decision-making processes aimed at strengthening the pediatric medicine security system, both within China and as a reference for other healthcare systems addressing similar challenges in pediatric medicine access.
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