Can the proposed HuiMinBao coverage of NRDL category C products really reduce inequities in access to innovative therapies in China?

The National Healthcare Security Administration (NHSA) has released the 2025 NRDL update, adding 114 drugs, including 50 innovative therapies. In parallel, China introduced its first national Commercial Insurance Innovative Drug List - NRDL Category C, which covers 19 high-value medicines such as CAR-T therapies, rare-disease treatments, and alzheimer’s drugs that fall outside basic medical insurance (NRDL Categories A and B).  

As Category C is set to take effect in 2026 and commercial insurers are not obligated to adopt its full list, an important question arises: can this new category reduce the substantial disparities in access that currently exist across cities with vastly different economic capacities? 

Understanding HuiMinBao and its connection with NRDL category C 

Unlike categories A and B, which are centrally funded, the newly introduced NRDL category C is intended to formalise coverage of high-cost, innovative medicines through national negotiation and oversight by the NHSA. By creating a standardised list of recommended high-value therapies, category C is expected to serve as a key reference for commercial insurers — particularly HuiMinBao schemes, which serve as a central channel for coverage. As these programmes update their local formularies, the category C list may help guide more consistent coverage decisions across regions. 

HuiMinBao itself is a locally administered supplementary insurance scheme designed to improve access to high- cost and life-saving therapies. These schemes have specialty drug lists that prioritise expensive treatments, and some cities even include medicines not yet approved in China. As a result, patients in economically stronger regions can access a broader range of critical therapies, while those in less developed areas face significantly fewer options — worsening regional disparities in access to healthcare. 

Current levels of nequity in HuiMinBao specialty drug coverage 

Although HuiMinBao programmes promise affordable health coverage, access to specialty drugs varies sharply among cities based on economic development. In our current analysis, we looked at HuiMinBao coverage across six representative cities: Beijing, Shanghai, Chongqing, Zhengzhou, Xiamen, and Enshi. 

Across the six cities examined, HuiMinBao collectively covers 68 therapies that fall outside NRDL Categories A and B. Most of these are oncology treatments (53 drugs), while only 15 target rare diseases. The variation across cities underscores persistent inequities in access to innovative therapies (Table 1). 

Beijing and Shanghai, with GDP per capita levels of ¥228,167 (£25,550) and ¥217,109 (£24,300), offer the broadest HuiMinBao specialty drug coverage, listing 90 and 63 therapies respectively. What sets them apart is their willingness to cover China-unauthorised medicines through designated pilot hospitals — 65 in Beijing and 28 in Shanghai.  

Cities with lower GDP per capita, including Xiamen at ¥151,697 (£17,000), Chongqing at ¥100,889 (£11,300), and Zhengzhou at ¥111,699 (£12,500), provide much narrower coverage, ranging from 27 to 38 specialty drugs. Their formularies exclude China-unauthorised medicines, yet each city has managed to include a small number of CAR-T therapies to address areas of high unmet need. 

At the lowest end of the economic spectrum, Enshi, with a GDP per capita of ¥43,691 (£4,900), covers only 24 specialty drugs and offers no CAR-T options. This clear gradient in coverage highlights the extent to which economic capacity continues to shape the breadth and sophistication of HuiMinBao benefits across China. 

Table 1. Comparison of Humanae specialty drug overage and economic indicators across six Chinese cities 

(*GDP per capita references: Beijing, Shanghai, Xiamen, Chongqing, Zhengzhou, Enshi)  

Wealthier cities such as Beijing and Shanghai offer far broader access to advanced therapies, including unapproved overseas drugs. In contrast, less developed regions like Enshi provide substantially fewer options. These disparities, driven by differences in economic capacity, policy implementation, and local resources, leave patients in lower-income areas with limited access to advanced care and highlight persistent health inequities. 

What is included in category C, and will it close the equity gap? 

The new category C list includes 19 innovative therapies spanning multiple disease areas. Of these, only seven are included in the HuiMinBao formularies of at least one of the six cities examined. Notably, 12 category C drugs — including one rare-disease therapy and nine oncology treatments — are absent from all six HuiMinBao formularies.

The addition of these treatments to category C signals a strong national commitment to expanding access to high-value therapies and will undoubtedly broaden patient access over time. However, HuiMinBao programmes are not obligated to adopt all category C listings, meaning local authorities will still have discretion over which therapies to include. Given the substantial geographic disparities identified in our analysis — and the relatively small number of drugs on the inaugural category C list, more than half of which are newly introduced — the impact on narrowing regional access gaps may be limited in the short term.

Nevertheless, category C represents an important milestone, establishing a national framework for incorporating innovative therapies, especially transformative treatments such as the two Alzheimer’s drugs lecanemab (Leqembi from Eisai) and donanemab (Kisunla from Eli Lilly) into future local benefit designs. This milestone clarifies the emerging reimbursement model in China: access to innovative, high-cost therapies will rely on a coordinated framework in which national and commercial insurance each play defined roles.

Looking ahead

While category C alone is unlikely to eliminate existing access gaps, its introduction represents meaningful progress towards establishing a more coherent and equitable system for covering high-cost therapies in China. The upcoming updates to HuiMinBao specialty drug lists will be crucial in determining how effectively this national framework translates into improved access to life-saving treatments across regions. 

At LCP Health Analytics, we are committed to helping clients navigate global market access challenges, including China’s rapidly evolving healthcare landscape. Whether you are exploring entry opportunities or are a global access strategy specialist wanting to understand what these NRDL developments mean with respect to your country prioritisation strategy, our experts can support you in navigating this complex system and help align learnings that can be applied when developing global access strategies.

To learn more about our market access expertise, please contact our Global Market Access Lead, Dr. Jasim Uddin.