Summary of Key Points
The 2026 National Essential Medicines List, which came into effect on September 1st, includes a total of 794 medications, an increase of 116 compared to the 2018 version (all of which are covered by medical insurance). Two chemical drugs were removed from the list. The most significant change in this adjustment is the more stringent and transparent selection process: companies cannot apply for inclusion; the decision is entirely made by experts, with supervision from departments such as public security and discipline inspection commissions. The criteria for selection require annual sales of at least 200 million units and solid clinical evidence of effectiveness. The old method of using connections to get drugs on the list is no longer effective. New additions include popular medications like semaglutide (used for diabetes and weight loss) and osimertinib (a targeted therapy for lung cancer), as well as many drugs for chronic diseases. The drugs that were removed are those that are rarely used or have significant side effects.
Companies whose products make it onto the essential medicines list can quickly gain a foothold in hospital markets, especially at hospitals above the secondary level. However, whether the "986 medication coverage targets" (90% at primary care levels, 80% at secondary levels, and 60% at tertiary levels) will continue to be enforced depends on future policies.
What's New in the Revised List?
The new list has expanded from 685 to 794 medications. The 116 additional drugs focus on areas such as diabetes, oncology, immunology, and chronic diseases:
- Diabetes: Semaglutide (used for weight loss) and insulin aspart (a commonly used rapid-acting insulin) have been included.
- Oncology: Osimertinib (a targeted therapy for lung cancer) and bevacizumab (an anti-cancer drug for colorectal cancer) have also been added.
- Chronic Diseases: Medications like montelukast (for asthma) and butylphthalide (for cerebral infarction) are now part of the list.
The drugs that were removed fall into two categories: those that are rarely used in primary care hospitals and those with serious side effects. Additionally, 75 dosage forms and 100 specifications were eliminated because they were not in use.
The Revised Selection Process
This selection process is completely different from before:
1. Companies cannot apply: Previously, companies could proactively submit applications to be included on the list; now, they can only wait for experts to make the decision.
2. Strict supervision: Public security, discipline inspection commissions, supervisory boards, and audit agencies are all monitoring the process to prevent any manipulation.
3. Two mandatory criteria: The drugs must meet both annual sales of at least 200 million units (indicating widespread use in primary care hospitals) and have solid clinical data proving their effectiveness.
Industry insiders say that those who previously claimed to have influence in getting drugs onto the list no longer have any power, as the rules are now transparent, and merit is the sole determinant.
The Benefits of Being on the Essential Medicines List
Being included in the essential medicines list means gaining a significant market advantage:
- Market share: For example, if there are 10 drugs in a certain area, the one on the list can capture 60% of the market, while the other 9 compete for the remaining 40%.
- Faster hospital adoption: Drugs, especially those for oncology, which were previously mainly used in top-tier hospitals, can quickly gain access to hospitals at lower levels.
- Reduced marketing costs: Companies do not need to spend much on marketing; the status of being an essential medicine itself provides protection, as hospitals prefer to use them in evaluations.
Companies that fail to make it onto the list face a tough situation: their competitors will gain market share, potentially leading to their own elimination.
Will the "986" Coverage Targets Continue?
When the 2018 version of the list was implemented, primary care hospitals were required to have at least 90% of their medications on the essential medicines list, secondary hospitals 80%, and tertiary hospitals 60%. Some hospitals found it difficult to meet these targets and sometimes purchased more expensive drugs just to meet the requirements. With the list expanding to 794 medications, industry experts speculate that:
- There is a high likelihood the "986" targets will continue: However, hospitals now have more flexibility in choosing medications, as they can select more practical ones from the expanded list.
- More flexible evaluations: The national policy emphasizes a "1+X" medication model (with essential medicines as the main focus and non-essential medicines as a supplement), and the use of essential medicines has been included in performance evaluations for public hospitals, making them more inclined to stock these drugs.
Why Were Innovative Drugs Included?
The biggest controversy surrounded the inclusion of high-priced innovative drugs, such as some targeted therapies for cancer, which can be expensive. The reasons for their inclusion are:
- High clinical demand: These drugs are effective, and many patients need them.
- Policy support for innovation: The government wants to promote domestic innovation, so four domestically developed, world-leading innovative drugs were included.
- Balancing multiple interests: Health authorities want to ensure patients have access to good medications, medical insurance departments need to control costs, and financial departments are concerned about spending at the grassroots level. Ultimately, the clinical value of these drugs was the deciding factor.
In summary, this revision of the essential medicines list aims to make high-quality and commonly used drugs more accessible to patients, while also sending a message to companies that product quality is more important than connections. For patients, it means they will have easier access to effective medications in hospitals.