China's national drug procurement and price negotiation policies significantly cut GLP-1 drug costs and increased their utilization by 212 defined daily doses per month in Shanghai.
+212 daily doses/monthNovel hypoglycaemic drug consumption increased by 212.28 defined daily doses per month after China's national price negotiation policy, a dramatic expansion of access
What the researchers found
National price negotiation led to a significant increase of 212.28 defined daily doses (95% CI: 188.25-236.31, p<0.001) in novel hypoglycaemic drug consumption. Daily costs decreased significantly after policy implementation (p<0.001). Dulaglutide, liraglutide, semaglutide, and dapagliflozin showed significant increases in utilization post-policy (p<0.001).
Why it matters
Drug pricing policy directly affects whether patients can access effective medications. This real-world evidence shows that government price negotiation can dramatically expand access to GLP-1 receptor agonists — drugs that have proven benefits for diabetes, obesity, and cardiovascular disease — by making them affordable at scale.
The numbers in context
Study period: January 2016 to December 2022 in Shanghai. Multiple rounds of national drug procurement and price negotiation policies were analyzed.
How the study worked
Interrupted time series analysis with segmented regression using drug procurement data from the Shanghai Medical Procurement Agency covering all public and private hospitals in Shanghai, January 2016 to December 2022. Analyzed volume, expenditure, and daily cost changes for specific drugs relative to policy implementation dates.
Who was studied
Shanghai diabetes drug market (procurement-level data)
What this study cannot tell us
Data is from Shanghai only, which is more developed than most Chinese cities — results may not generalize to rural or less economically developed regions. The study measures procurement volumes, not individual patient outcomes or adherence. It cannot distinguish whether increased utilization led to improved health outcomes. The study period ended in 2022 and doesn't capture the more recent semaglutide demand surge.
How to read the evidence
Moderate evidence from a well-designed interrupted time series analysis using comprehensive citywide procurement data, though limited to one city and measuring utilization rather than clinical outcomes.
When this study was published
Published in 2024, analyzing data through December 2022. The GLP-1 market has changed significantly since then with surging global demand.
The bigger picture
As GLP-1 receptor agonists demonstrate benefits beyond diabetes — including weight loss and cardiovascular protection — their high cost is a major barrier worldwide. China's approach of centralized price negotiation offers a model for how government policy can dramatically expand access to these medications, relevant to global discussions about drug pricing and access.
Questions still open
- Did the increased utilization of GLP-1 drugs actually translate to improved diabetes outcomes at the population level in Shanghai?
- How do China's price negotiation results compare to GLP-1 drug pricing in other countries like the US and Europe?
Common questions
How did China manage to lower GLP-1 drug prices?
Did cheaper GLP-1 drugs in China mean more people used them?
Read the original research
Analysing the effects of National Centralised Drug Procurement and Price Negotiation Policies on novel hypoglycaemic drug usage and costs in Shanghai, China: an interrupted time series analysis.
BMJ open, 14(12), e088318
Citation
Song, Jie; Guo, Wei; Jin, Chunlin; Xu, Yuan; Hu, Xiaojing; Zhang, Zheng; Lin, Hai. (2024). Analysing the effects of National Centralised Drug Procurement and Price Negotiation Policies on novel hypoglycaemic drug usage and costs in Shanghai, China: an interrupted time series analysis.. BMJ open, 14(12), e088318. https://doi.org/10.1136/bmjopen-2024-088318