Balancing medical innovation and affordability in the new healthcare ecosystem in China: Review of pharmaceutical pricing and reimbursement policies

Global harmonization in advanced therapeutics: balancing innovation, safety, and access

INTRODUCTION

Advanced Therapy Medicinal Products (ATMPs), which include gene therapies, somatic cell therapies, and tissue-engineered products, are a new paradigm for treating previously intractable diseases. Their regenerative and personalized approach makes them, unlike conventional treatments, require changing regulatory systems to adjust to their intricacies.

AREAS COVERED

This review gives a comprehensive critique of international regulatory programs that include the FDA's RMAT designation, EMA's PRIME program, and Japan's Sakigake program intended to bring ATMPs to patients faster while ensuring patient safety. It also considers innovation-led strategies like adaptive licensing, rolling reviews, and real-world evidence (RWE) led decision-making for pre-market authorization and post-market monitoring. In addition, it discusses problems like regulatory divergence, intricate manufacturing standards, price constraints, and the transformative role of digital technologies such as artificial intelligence and blockchain in traceability and regulatory compliance. Patient-centric models and early access schemes are also extensively debated as part and parcel of the future of regulatory science.

EXPERT OPINION/COMMENTARY

To achieve the maximum potential of ATMPs across the world, regulatory systems need to be harmonized and responsive, involving real-time data analysis, flexible approval processes, and improved stakeholder cooperation. New technologies, coupled with more patient engagement and global convergence efforts, are crucial for providing equal access to effective and safe advanced therapies.

Current challenges and future perspectives of drug discovery in China

INTRODUCTION

China's pharmaceutical industry, which is historically centered around generic medicines, has largely transformed from imitation to innovation over the past three decades. Despite unprecedented progress, critical challenges remain such as insufficient indigenous research funding, underdeveloped academia-industry relationships, and significant barriers to market access.

AREAS COVERED

This perspective examines the evolving pharmaceutical landscape of China, focusing on its participation in global clinical trials and the resultant new drug approvals. Data for this analysis was sourced from several databases (e.g. PharmCube, NextPharma, and PharmaGO), academic reports, and published literature, covering data up to 2024 (unless otherwise specified). This perspective highlights ongoing regulatory challenges, such as inconsistencies in product standards, and the approval processes relative to the U.S.A. and the European Union. There is also an urgent demand for sustained international investment and recognition, partially due to the recent changes in the geopolitical environment. This perspective also discusses China's efforts to implement accelerated approval pathways and foster multilateral development collaborations.

EXPERT OPINION

China must align its regulatory policies more closely to the international norm to generate robust trial data that will be readily acceptable to the FDA and EMA. Continued investment in biologics as well as cell and gene therapy and artificial intelligence will drive innovation and enhance competitiveness. Additionally, strengthening the academia-industry collaboration is crucial to obtaining new leads through translational research. Ultimately, structural reforms are required to solidify the country's goal of becoming a major player in the global pharmaceutical market.

Analysis of drug pricing drivers under South Korea's pharmaco-economic evaluation exemption policy (2015-2022)

Objective

This study analysed the characteristics of new drugs listed under the pharmaco-economic evaluation exemption (PEE) system from 2015 to 2022 in South Korea and examined the factors influencing the pricing decisions under this system.

Methods

A mixed-methods statistical approach was used to comprehensively evaluate the factors influencing drug pricing under PEE system. Descriptive statistics provide an overview of the dataset, while inferential statistics, including t-tests and Pearson's correlation analyses, are used to explore variable associations. Multiple and hierarchical regression models identify and quantify the key determinants of drug prices, controlling for multicollinearity among the variables.

Results

From 2015 to 2022, 30 new drugs were listed under the PEE system. The average annual number of new drugs was four, but this figure significantly increased to eight in 2022. The "KOR/A7 lowest" variable exhibited a strong negative correlation with the budget impact variable (coefficient: 0.838, P < 0.001), indicating that drugs with higher budget impact tend to have lower prices compared to the A7 countrie's lowest price.

Conclusion

Since the introduction of the PEE system in South Korea, patient access to new drugs has significantly improved. However, the rising expenditure on pharmaceuticals has made budget impact a significant consideration in pricing decisions, highlighting the need for ongoing monitoring of drug expenditure by payers. As the system evolves, enhanced oversight and policy adjustments will be crucial for balancing cost containment with equitable patient access. Developing tiered RSA models based on drug classification or therapeutic impact could be a viable approach to achieving this balance.