Physician Perspectives and the Impact of Payer Policy on Prescribing

An estimated 121 million people are living with chronic kidney disease (CKD) in China. This high prevalence can be attributed to China’s aging population as well as an increase in the prevalence of hypertension and diabetes, which substantially increase the risk of CKD. Complications arising from CKD include anemia and mineral disorders such as hyperphosphatemia and secondary hyperparathyroidism. These complications present opportunities for drug treatment. However, owing to a multitude of factors, including limited access to newer drugs with better efficacy and safety profiles, many patients are being treated suboptimally with existing anemia therapies. Erythropoiesis-stimulating agents (ESAs) are the most commonly used drug in the treatment of renal anemia. Although ESAs can be reimbursed partially through the state insurance schemes, the out-of-pocket expenses associated with these agents are still considered too high for many patients. Moreover, only short-acting ESAs are currently available. The limited treatment options for CKD create an opportunity for oral drugs with a new mechanism of action, such as AstraZeneca/FibroGen’s hypoxia-inducible factor prolyl hydroxylase inhibitor roxadustat (especially for CKD patients not on dialysis), and for long-acting ESAs (e.g., Jiangsu Hansoh Pharmaceutical’s EPO-018B [pegol-sihematide]) to address unmet needs in the Chinese market.

Questions Answered in This Report:

  • Current therapies for CKD in China: What are the current prescribing patterns for renal anemia and hyperphosphatemia? How do physicians expect these trends to evolve over the next few years? What are the current brand shares of ESAs and phosphate binders?

  • Market access opportunities and challenges of CKD drugs in China: What is the reimbursement landscape for ESAs, iron supplements, and phosphate binders? How does it affect these agents’ current patient (or brand) shares?

  • Emerging therapies for CKD in China: What are payers’ views on the pricing and reimbursement landscape for emerging CKD drugs? What are the forces that will shape the market for these novel drugs? What therapies do payers expect to be included in the new versions of the National Reimbursement Drug List (NRDL) and/or Provincial Reimbursement Drug Lists (PRDLs)?


Markets covered: China.

Primary research: 51 nephrologists completed an online quantitative survey designed by therapeutic and country experts; Three interviews were conducted with payers/payer-advising thought leaders who have influence on patient access to CKD drugs at a regional or national level.

Epidemiology: Diagnosed prevalent cases of CKD.

Emerging therapies: Phase III: One drug; Phase II: One drug.

Author(s): Jonathan Chan, M.MedSc.
John Pong, Ph.D.
Michelle Zhou, M.B.B.S., Ph.D.