Drug price trends, regional disparities, and supply shortages under China's National Volume-Based Procurement: a...

The National Volume-Based Procurement (NVBP) policy was implemented in China in 2018 to address escalating pharmaceutical expenditures. This study aimed to describe long-term price trends, regional variations in bid-winning drug prices, and supply stability during the 2018-2024 implementation period.

Data were obtained from the Shanghai Sunshine Pharmaceutical Procurement Platform and the Comprehensive Service Platform for NVBP. Price trends of bid-winning and alternative drugs were analyzed using monthly procurement data for Batches 1-7, excluding the insulin-specific sixth batch.Laspeyres, Paasche, and Fisher price indices were calculated using January 2018 as a common index anchor to standardize long-term price comparisons, rather than as a batch-specific pre-policy baseline. Regional disparities in bid-winning drug prices were examined using official bid-winning results for Batches 1-5 and Batches 7-10, with purchasing power parity indices estimated by the national product dummy method. Supply shortages were measured as monthly regional order-delivery gaps during the first post-implementation year of each included batch and classified into five severity levels.

Bid-winning drugs showed substantial price declines after implementation, with Laspeyres, Paasche, and Fisher indices decreasing by approximately 55%-85%, 60%-85%, and 50%-80%, respectively. Prices remained stable at low levels without obvious rebound. Alternative drugs showed smaller and more fluctuating declines of approximately 5%-40%, 5%-40%, and 10%-40%, respectively. Supplementary interrupted time-series analysis of the Fisher index showed significant negative immediate level changes for bid-winning drugs across all included batches, whereas alternative drugs showed smaller and less consistent immediate changes. Regional PPP point estimates were generally lower in economically developed regions than in the western region, although many individual batch-region comparisons were not statistically significant. First-year supply shortages ranged from approximately 17% to 33% across batches. Lower-priced drugs were more frequently observed in higher shortage-severity categories, with drugs priced below 0.5 CNY accounting for 77.6% of severe shortages.

This nationwide descriptive study documented sharp and sustained price declines for bid-winning drugs, smaller and heterogeneous declines for alternative drugs, persistent regional price disparities, and supply shortages under China's NVBP. These findings suggest a policy tension between price reduction, regional equity, and supply security.If these descriptive associations reflect underlying procurement mechanisms, future policy refinements may consider regional price-differential monitoring, dynamic price-adjustment mechanisms for extremely low-priced drugs, supply guarantee requirements, and reward-penalty mechanisms for procurement participants.