Five Policy Signals from China's 15th Five-Year Plan That Will Reshape Pharma Market Access by 2030

The coverage of China's 15th Five-Year Plan has focused on big themes for the pharma industry: the acceleration of the domestic innovation pipeline, the funded rollout of elderly care and long-term insurance infrastructure, the tension between formal commitments to national treatment (the principle that foreign companies must be given the same market conditions as domestic companies) and equally explicit indigenisation policy, and the structural shift of the health system toward primary care and chronic disease management. For pharma and biotech market access teams, these factors will shape access, pricing and positioning decisions through 2030.

Original innovation is now a reimbursement signal, not just an R&D goal

The plan commits explicitly to "decisive breakthroughs" in biomanufacturing, advanced materials, integrated circuits and AI, underpinned by increased basic research funding, enhanced R&D tax deductions, and coordinated state investment directed at priority technologies. For domestic firms, this is a policy-backed growth runway. For multinational companies (MNCs), it is a structural challenge.

It is worth being precise here: the plan does not explicitly prioritise domestically manufactured products for reimbursement. However, the signals pointing in that direction are consistent and specific. Section 11 commits to “decisive breakthroughs” across entire technology chains in “biomanufacturing”, backed by coordinated state funding that goes beyond normal governmental budgeting. Section 12 explicitly states that the government will “increase procurement of homegrown innovative products”. Taken together with Section 42’s commitment to “support the development of innovative drugs”, framed in terms of domestic development, these factors create a policy environment in which domestic originators will be structurally advantaged, even in the absence of a formal reimbursement preference. Therefore, as the domestic pipeline matures, payers may ask what a foreign product offers that no Chinese originator can deliver within the planning horizon.

Explicit support for elderly care and chronic diseases will shape healthcare investment

Population ageing is one of the most operationally detailed sections of the entire document. Long-term care insurance is being rolled out, elderly care service networks are mandated in both urban and rural areas, rehabilitation and hospice care are explicit priorities, and the statutory retirement age is being raised gradually.

Furthermore, the document includes the specific objective to “develop the silver economy”. This is not aspirational language, it is a funded, structured commitment that will reshape which therapeutic areas receive preferential reimbursement attention over 2026-2030. The plan commits to "comprehensive prevention and control of chronic diseases" and "end-to-end services covering prevention, treatment, rehabilitation, and health management." While the plan does not name specific therapeutic areas, oncology, neurodegenerative disease, cardiometabolic and musculoskeletal conditions are all consistent with where the system is being built to invest, given the demographic direction of travel.

Foreign firms are promised equal market access, but the plan also backs the domestic industry

Section 23 of the document formally commits to national treatment for foreign funded enterprises, meaning that foreign companies should receive the same market access and competitive conditions as their Chinese counterparts, with no discriminatory barriers. However, the plan also commits to homegrown procurement preferences, indigenous supply chain resilience, domestic originator support, and improved centralised medicine procurement policies.

These two commitments sit in direct tension, and structural policy incentives for domestic companies tend to dominate formal pledges of equal market conditions for foreign and domestic players. Access scenarios for China that assume the stated openness will operate without friction are likely to be optimistic.

On pricing and procurement specifically, Section 40 commits to improving "centralised medicine procurement" and "medical insurance payment" policies, two levers that define how Volume-Based Procurement (VBP), China's national tendering system where drugs compete on price in exchange for guaranteed prescription volume, operates in practice. Section 42 reinforces this by committing to "coordinated development and governance of medical services, medical insurance, and pharmaceuticals" as an integrated system. This signals that centralised procurement is not being wound back; it is being refined and extended. For companies in therapeutic areas not yet subject to VBP rounds, the question may not be whether volume-based tendering will reach them, but when and on what terms.

Shifts toward primary and community care will change where and how drugs are prescribed

Section 42 mandates reform of public hospitals, including staffing, service charges and remuneration, alongside a deliberate shift of care toward community and primary-care settings. It commits explicitly to strengthening "county, district, and community-level medical institutions" and to "tiered diagnosis and treatment" as a structural principle, meaning patients will be increasingly directed to the lowest appropriate level of care rather than defaulting to hospital settings.

For market access teams, reimbursement and uptake are increasingly determined not just by central NRDL listing, but by how products fit into the care pathway at provincial and local level. A drug that is listed but not routinely prescribed at the community level, where the target population is increasingly being managed, will have limited real-world access. Provincial and local formulary dynamics, prescribing habits at primary care level, and fit with the tiered care pathway will become increasing important considerations for value & access strategy development and implementation.

What this means for China value & access strategy development

China's 15th Five-Year Plan provides a substantial, detailed signal for where health system priorities, funding and incentive structures are heading over the next five years. The plan does not speak directly to pharmaceutical market access mechanisms such as the NRDL or VBP, but the structural direction it sets has clear implications for how companies will need to position, price and access the market.

The broad direction is clear: lead with genuine clinical differentiation, align therapeutic area narratives to ageing and chronic disease priorities, do not assume stated openness will override structural indigenisation pressure, and get closer to the provincial and community-level access architecture to ensure optimal access and uptake for new therapies.

Sources

1.     Xinhua. Full text: Recommendations of the Central Committee of the Communist Party of China for Formulating the 15th Five-Year Plan for National Economic and Social Development. (2025). Available from: https://english.news.cn/20251028/efbfd0c774fd4b1c8daeb741c0351431/c.html

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