Public hospital prescriptions for generic drugs are being rejected by patients, who are instead purchasing more expensive brands online.
After years of buying Adalat to control her high blood pressure, Beijing woman Sophie Chen started noticing from 2023 that the medication – produced by German pharmaceutical company Bayer – was gradually disappearing from Chinese public hospitals.
Instead of paying 20 yuan (US$2.75) for the original brand-name medication, her doctors now prescribe a domestically produced generic version that costs only 4.27 yuan (59 cents) per box.
However, Chen claimed that since starting the generic drug, she has experienced additional negative effects, such as an increase in her heart rate. She could reach 70 beats per minute with Adalat and another medication that lowers her heart rate. She continued, “Now it is at 80 or 90.” Chen said she was considering other options, including the possibility of paying for branded medicines out of her own pocket in local pharmacies. “I don’t mind taking generic medications, but what if they don’t do a good job of keeping my blood pressure under control? That would be fatal for me.”
Her story encapsulates the debate over China’s reforms to pharmaceutical procurement.
Since 2018, there have been multiple rounds that have led to exceptionally low drug prices, including aspirin at less than one US cent per tablet, most recently in December.
In a bid to cut state spending on healthcare, Chinese authorities have been bulk buying medicines for use in public hospitals and lowering prices through negotiations and bids.
But in recent months, there has been public anger over concerns that the cheaper generic drugs which replaced the original brand-name medicines in public hospitals and the national insurance scheme are ineffective.
Although the government provided a rare response in which it denied that this was the case, it did little to calm public concern given the growing dissatisfaction with the medical system, which has historically been one of the country’s proudest achievements. Among those speaking out were many in the medical community.
Zheng Minhua, a seasoned Shanghai doctor, expressed his concerns in January regarding “laxatives that did not clear the bowel and anaesthetics that cannot put patients to sleep.” In a proposal to Shanghai authorities made with 20 other doctors, Zheng said that procurement prices were too low, which led to companies producing ineffective medicines, which doctors had no choice but to use.
Medical officials from the National Healthcare Security Administration (NHSA) immediately followed up on the complaints, saying in a report broadcast by state broadcaster CCTV on February 9 that the claims were based on “people’s anecdotes and subjective feelings”.
The statement added that China’s evaluation of generic medicines followed Western standards, and the quality is strictly supervised, including after they are put on the market.
But some members of the public have questioned the official assurances and are finding other ways to acquire branded medicines which they regard as safer than the lower priced generics.
People have posted about their purchasing experiences on social media, including finding overseas agents and buying from online shops. Some of them advised people to always check their medications and included lists of treatments for common illnesses.
Even if they are willing to pay for them and forego compensation from the national medical insurance system, there have been reports of people hoarding up to three years’ worth of medicines out of fear that the branded versions could disappear from the Chinese market.
Frank, a bank analyst in Shanghai, stated that the efficiency of the prescribed medications from public hospitals has disappointed him. He has opted to buy the original branded versions of all his family’s medicines from pharmacies or online shops.
These include antihypertension medicine and antibiotics for one of his parents, as well as Cetirizine, a treatment for allergies, for himself. “It cost me a lot more, but the effects have been great. He stated, “I will easily sleep through the night with just one pill.” Another doctor, a neurologist, expressed dissatisfaction, stating that they had little control over the situation.
Their performance and bonuses were contingent on the number of prescriptions they filled, and they were required to prescribe medications from the bulk buying list. Chinese authorities have always boasted of the wide coverage and affordability of China’s medical insurance as a political landmark.
In a government work report delivered at the 2023 annual Two Sessions, then premier Li Keqiang said China in the previous five years had “provided basic medical system as a public product to the people, further alleviating the problem of high cost and difficulty to obtain medical treatment”.
Additionally, he stated that the price of acquiring medical supplies and equipment had decreased by more than 400 billion yuan (US$55 billion). NHSA officials were hailed as heroes when video clips of their harsh bargaining for cheaper medicines went viral on China’s social media platforms.
A common response was, “You have to let the poor be able to afford medicine.” However, precisely this is what has resulted in the current controversy. According to a Guangdong health official, a major problem is that “the pricing of medicine has become almost the sole goal for the national medicine bulk buy process”, with the overriding priority of bringing the national health insurance fund’s deficit under control.
“With a rapidly ageing population, China’s spending on medical care has been rising quickly. The key job now is to manage the rising cost before the whole healthcare system crumbles,” he said.
“Beijing has launched many initiatives, including medicine bulk purchases, pushing for more domestically produced drugs and a major anti-corruption campaign in the healthcare system. All serving a single objective, which is to reduce costs. There are calls to leave an alternative way open for people who can afford the more expensive branded medicines.
In his proposal, Zheng wrote that doctors should have the right to suggest them for better treatment when patients were willing to pay for them out of their own pockets.
Sun Liping, a well-known sociologist, wrote on the social media platform WeChat that “it’s ridiculous that people still have to take ineffective or even harmful substandard products even with our medical technology.”
The bottom line is that medicine must treat diseases and be effective. He wrote, “There will be a crisis of trust in the medical system if that bottom line is lost.”
