Summary of Key Points
The supply of cyclophosphamide, a classic chemotherapy drug, has recently become tight. This medication is classified as a Class A drug under medical insurance and is part of the national essential medicines list, with a wide range of clinical uses (cancer treatment, autoimmune diseases, immunosuppression after organ transplants, etc.). However, due to production issues with the original brand and insufficient or unwilling production by generic manufacturers, coupled with its low price and limited sales volume, companies lack the incentive to produce it. The shortage directly affects patient treatment, highlighting the challenges in supplying essential, yet inexpensive drugs.
1. The Importance of Cyclophosphamide as a Critical Cancer Treatment Drug
Cyclophosphamide is no ordinary drug; it is a “essential tool” in doctors’ arsenals:
- In cancer treatment: It is almost always used as a first-line therapy for lymphoma and is frequently prescribed for breast cancer, as well as leukemia, ovarian cancer, and pediatric rhabdomyosarcoma.
- For other diseases: It is used to treat autoimmune conditions such as rheumatoid arthritis and lupus erythematosus, and to suppress rejection reactions after organ transplants.
- Policy perspective: Its classification as a Class A drug under medical insurance (high reimbursement rate) and its status as a national essential medicine indicate that it is a vital medication for both patients and doctors.
2. The Causes of the Supply Shortage: Both Original Brand and Generic Manufacturers Are at Fault
The shortage is not due to a single factor but a combination of problems with both the original brand and generic versions:
- Original Brand: Baxter, the market leader, experienced technical issues this year with its manufacturers, which reduced production capacity significantly.
- Generic Manufacturers: Only four companies in the country have approval to produce cyclophosphamide, but the situation is problematic: some have stopped supplying due to shortages of raw materials, others face complex manufacturing processes that take time, and some have the approval but do not actually produce the drug.
- Market structure: The original brand holds 71.78% of the market share, while generic drugs together account for less than 30%. A shortage in the original brand can severely impact the entire market.
3. Why Are Inexpensive Drugs Always in Short Supply? Low Profitability Deters Production
The low price of cyclophosphamide is a double-edged sword:
- Low cost: 200mg costs only 24.57 yuan, 500mg less than 100 yuan, and 1g costs 160 yuan.
- Limited sales volume: Annual sales in hospitals nationwide are less than 300 million yuan, with just 78 million yuan in the first half of 2026.
- Lack of incentive for companies: Producing this drug is not profitable; in fact, it can be costly. Who would invest in the necessary equipment and manpower? Even with approval, companies may simply choose not to produce it—after all, they are not charities.
4. The Impact of the Shortage on Patients and Treatment
The shortage directly affects patients:
- Lymphoma patients: There is no alternative, so treatment must prioritize those who have no other options.
- Breast cancer patients: Oral versions are available, but the dosage and side effects differ, requiring doctors to adjust the treatment plan, which can be challenging for patients.
- Hospitals: They either struggle to find the drug or face limited supply, disrupting the treatment process and causing anxiety for both doctors and patients.
5. The Need to Address the Shortage of Inexpensive Drugs
This shortage serves as a reminder that the supply of essential, inexpensive drugs cannot rely solely on companies’ voluntary efforts. Policy intervention is necessary—such as establishing stockpiling mechanisms, providing subsidies to manufacturers, and ensuring the availability of raw materials—to prevent these life-saving drugs from disappearing. After all, for patients, even the cheapest drug can be a matter of life and death when it is unavailable.