China's National Joint Drug Procurement Office released the final drug list for the 7th volume-based procurement (VBP) on July 18. The list covers 60 categories of drugs, including Metformin Hydrochloride and Vildagliptin Tablets (II) and Pioglitazone Hydrochloride Tablets/Capsules for treating diabetes.
Related: China Unveils the Final Drug List for the 7th VBP
Overview of Diabetes Drugs in VBPs
China piloted VBP for the first time in four municipalities (Beijing, Tianjin, Shanghai, Chongqing) directly under the central government's administration and seven cities (Shenyang, Dalian, Xiamen, Guangzhou, Shenzhen, Chengdu, and Xi'an) at the end of 2018, and then expanded VBP to the national level in 2019. So far, China has organized national VBP for seven times, which include 15 chemical drugs and 12 insulins for diabetes treatment.
VBP | Date of Releasing the Final Drug List for VBP | Procurement Term | Number of Diabetes Drugs |
Pilot in 4+7 cities | 17/12/2018 | 1 year | 0 |
Pilot nationwide (1st) | 30/09/2019 | 1-2 years | 0 |
2nd | 21/01/2020 | 1-3 years | 2 |
3rd | 24/08/2020 | 1-3 years | 2 |
4th | 08/02/2021 | 1-3 years | 5 |
5th | 28/06/2021 | 1-3 years | 4 |
6th (exclusive for insulins) | 30/11/2021 | 2 years | 12 |
7th | 18/07/2022 | 1-3 years | 2 |
Total | 27 | ||
Specifics of the 27 diabetes drugs in VBPs:
National VBP | Diabetes Drugs |
2nd | 1) Acarbose, tablets/capsules; 2) Glimepiride, tablets |
3rd | 1) Metformin Hydrochloride, tablets / sustained-release tablets; 2) Vildagliptin, tablets |
4th | 1) Empagliflozin, tablets 2) Canagliflozin, tablets 3) Repaglinide, tablets 4) Nateglinide, tablets 5) Gliclazide, sustained-release tablets |
5th | 1) Glipizide, tablets / controlled-release tablets 2) Saxagliptin, tablets 3) Miglitol, tablets 4) Thioctic Acid, injection |
6th | 1) Human Insulin Injection (30R) 2) Isophane Protamine Recombinant Human Insulin Injection 3) Mixed Protamine Human Insulin Injection (30R) 4) Mixed Recombinant Protamine Human Insulin Injection (30/70) 5) Insulin Aspart Injection 6) Recombinant Human Insulin Lispro Injection 7) Insulin Glarlisine Injection 8) Recombinant Insulin Glargine Injection 9) Insulin Detemir Injection 10) Insulin Degludec Injection 11) Mixed Protamine Zinc Recombinant Human Insulin Lispro Injection (25R) 12) Insulin Aspart 30 Injection |
7th | 1) Metformin Hydrochloride and Vildagliptin, tablets (II) 2) Pioglitazone Hydrochloride, tablets/capsules |
Sales Values Changes of 27 Diabetes Drugs in China’s Public Healthcare Institutions
In the year of 2018 when the 27 diabetes drugs had not been included in VBPs yet, their total sales value in public healthcare institutions was 47.5 billion yuan (circa 7.03 billion USD). In 2021, their total value dropped to 44.7 billion yuan. The decline is mainly attributed to the sharp price cuts despite the increasing volumes brought by the VBPs.
Sales Values of 27 Diabetes Drugs in 2018 and 2021, Data Source: Menet.com.cn
Notes: all the market data in this article refer to those of China's public healthcare institutions, including public hospitals and healthcare centers.
Although the total sales value decreased, certain drugs, e.g., Empagliflozin, Canagliflozin, and Glipizide, realized increases in sales values.
Two SGLT2 inhibitors—Empagliflozin and Canagliflozin—witnessed sales value growths from 2018 to 2021. The two drugs' sales value were about 60 million yuan and 100 million yuan respectively in 2018, and rose to 200 million and 300 million in 2021.1
Glipizide, which was included in the 5th VBP in 2021, saw the sales value increased from nearly 900 million yuan in 2018 to over 1 billion yuan in 2021.
Differently, Acarbose and Glimepiride, experienced the declines in sales values after the 2nd VBP. Acarbose's sales value was 8.4 billion yuan in 2018, then soared to 9.6 billion yuan in 2019, but dropped to 2.4 billion yuan in 2021. Glimepiride's sales value exceeded 2.4 billion yuan in 2018, then climbed to 2.7 billion yuan in 2019, but fell to 0.7 billion yuan in 2021. The declines have two main reasons: (1) the increases in sales volumes could not offset the extremely low prices; (2) more diabetes drugs entered the subsequent VBPs and competed with Acarbose and Glimepiride.
For insulins in the 6th VBP, their total sales volume grew from 23 billion yuan in 2018 to 28.2 billion yuan in 2021. However, Gan & Lee Pharmaceutical, whose 6 insulin products are included in the 6th VBP, estimates that its net profits will decrease in H1 2022. The company explained that it won the VBP bid to supply large volumes of insulin products but the prices were reduced sharply. As the 6th VBP was started from May 2021 and is still going on, the narrowed profit margin may be made up by higher sales volumes.
As the 7th VBP is expected to be carried out in Q4 2022, the sales changes are still pending for the two involved diabetes drugs—Metformin Hydrochloride and Vildagliptin (a compound drug), and Pioglitazone Hydrochloride.
Diabetes Drugs with Huge Market Potential
Among the 27 diabetes drugs, quite a few drugs in the VBPs belong to GLP-1 receptor agonists, DPP-4 inhibitors, SGLT2 inhibitors, and compound antidiabetic agents, which were among the top 5 types of diabetes drugs in terms of market share in Q1 2022.
Table 1: Top 5 Types of Diabetes Drugs Sold in Public Healthcare Institutions in China | ||||
Top | 2018 | Q1 2022 | ||
Type | Market Share | Type | Market Share | |
1 | Insulins and their biosimilars | 37.12% | Insulins and their biosimilars | 40.68% |
2 | Alpha-glucosidase inhibitors | 19.40% | GLP-1 receptor agonists | 12.26% |
3 | Biguanides | 9.36% | DPP-4 inhibitors | 11.64% |
4 | Sulfanilamide, urea derivatives | 8.68% | SGLT2 inhibitors | 10.71% |
5 | Other diabetes drugs | 8.08% | Compound antidiabetic agents | 5.83% |
Data source: Menet.com.cn | ||||
Some SGLT-2 inhibitors (e.g., Dapagliflozin) and DPP-4 inhibitors (e.g., Linagliptin) had impressive market performances, getting into the top 10 ranking in Q1 2022.
Table 2: Top 10 Diabetes Drugs Sold in Public Healthcare Institutions in Major Chinese Cities | ||||
Top | 2018 | Q1 2022 | ||
Drug | Market Share | Drug | Market Share | |
1 | Acarbose | 17.08% | Insulin Glargine | 13.05% |
2 | Insulin Glargine | 12.86% | Insulin Aspart | 10.82% |
3 | Insulin Aspart | 10.53% | Dapagliflozin | 8.44% |
4 | Metformin | 9.36% | Sitagliptin | 5.67% |
5 | Lipoic Acid | 5.72% | Liraglutide | 5.57% |
6 | Isophane Protamine (Recombinant) Human Insulin / Isophane Protamine Human Insulin | 5.15% | Linagliptin | 4.15% |
7 | Glimepiride | 4.40% | Dulaglutide | 4.09% |
8 | Recombinant Lispro Insulin | 3.66% | Insulin Degludec | 4.02% |
9 | Repaglinide | 3.65% | Epalrestat | 3.52% |
10 | Sitagliptin | 3.44% | Metformin | 3.24% |
Data source: Menet.com.cn | ||||
The data listed above shows the future market trends. Diabetes drugs in China used to be mainly insulins, biguanides, sulfonylureas, and alpha-glucosidase inhibitors. Currently, new types of diabetes drugs such as GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT2 inhibitors are not dominant in the Chinese market. But as the two tables shown above, the new types are rising in market shares with huge market potential.
China Diabetes Market Shares in 2020, Data Source: Frost & Sullivan,Askci.com
