Warfarin has been the mainstay of anticoagulation therapy for the past several decades, but difficulties associated with its use and the clinical management of patients have prompted the development of novel oral anticoagulants (NOACs). The anticoagulant effects of these new agents allow for their use across multiple indications such as venous thromboembolism (VTE), atrial fibrillation (AF), and acute coronary syndrome (ACS). In China, approvals of several NOACs such as Pradaxa (Boehringer Ingelheim’s dabigatran etexilate), Eliquis (Bristol-Myers Squibb/Pfizer’s apixaban), and Xarelto (Bayer/Janssen’s rivaroxaban) in recent years have increased the availability of these drugs in the country and broadened treatment options for physicians and patients. The inclusion of Xarelto into the National Reimbursement Drug List (NRDL) as a type B drug may be the country’s first sign of readiness to adopt other NOACs into the national health insurance coverage.

Questions Answered in This Report:

  • How does access to therapies for VTE, AF, and ACS actually take place, and especially to NOACs?

  • How frequently are physicians still prescribing warfarin?

  • How do prescribing patterns for Xarelto, Pradaxa, and Eliquis differ, and why? How do cardiologists expect prescribing to evolve by 2016?

  • How will physicians increase prescribing of a NOAC if it is incorporated into the NRDL?

  • What policy changes and government initiatives may affect the prescription of NOACs for anticoagulation therapies?

  • Which agents are currently included on the NRDL and/or Provincial Reimbursement Drug Lists (PRDLs), and what reimbursement restrictions apply? What therapies do payers expect to be included in the new versions of the NRDL and/or PRDLs?

  • How might reimbursement of currently approved NOACs change in the near future?

  • How might the new non-essential drugs’ tendering and other new government initiatives affect the pricing and the reimbursement of anticoagulation therapies?

  • How does the approval of new drugs or new indications in the United State and Europe affect the approval process in China?

  • How familiar are physicians with Lixiana/Savaysa?

  • How will cardiologists change their prescribing patterns in the next three years, assuming expansion of indications for currently marketed brands, and the approval of Lixiana/Savaysa (Daiichi Sankyo’s edoxaban)?

  • What clinical and commercial factors would most likely convince payers to grant emerging agents coverage or advantaged positioning?

  • How will payer policy (e.g., inclusion in government formularies/drug lists) actually impact uptake of emerging oral anticoagulants?

  • How will market access barriers in China evolve, and what challenges are companies likely to face in the future?


Decision Resources Group’s Emerging Markets Physician & Payer Forum report “Novel Oral Anticoagulants in China: Physician and Payer Perspectives on the Evolving Treatment of Venous Thromboembolism, Atrial Fibrillation, and Acute Coronary Syndrome” explores the prescribing patterns of current anticoagulant therapies, the impact of increased access and availability of NOACs, and key national and regional market access factors that will shape the use of novel drugs for VTE, AF, and ACS treatment in China in the next two to three years. It draws on insights from 50 surveyed cardiologists and from interviews with 3 interviewed payers in China, all of whom have influence at a national or regional level. Interviewed payers include the following:

- NRDL panel member, Beijing: Hospital chief physician, director of cardiology, professor of clinical integrative medicine.

- CFDA consultant, Beijing: Hospital chief physician, deputy director of clinical pharmacology center, member of Beijing municipal committee of clinical pharmacology, Beijing health insurance accreditation expert.

- NRDL panel member, Hunan: Hospital professor, member of Medical Society of Cardiology Professional Committee, fellow of American College of Cardiology.

Author(s): Jonathan Chan, M.MedSc.