Nationwide cross-sectional survey finds varied pricing relationships in 63 fixed-dose and free-equivalent groups in China’s NRDL

A nationwide cross-sectional study found that the median unit-price ratio between fixed-dose combination medicines and corresponding free-equivalent combinations was 0.94 among 63 FDC–FEC groups included in China’s 2022 National Reimbursement Drug List. The ratio had an interquartile range of 0.55–1.44 and a range of 0.18–3.34; 35 of 63 groups, or 55.56%, had ratios below 1.

The analysis used 2023 price data for fixed-dose combinations in the 2022 reimbursement list that had identifiable free-equivalent comparators. Under Chinese differential pricing rules, researchers adjusted the component prices of each free-equivalent combination to match the strength and dosage form of the corresponding fixed-dose product. Each fixed-dose unit price was then divided by the sum of the adjusted free-equivalent component prices. Medians and interquartile ranges summarized the ratios, while Kruskal–Wallis and Wilcoxon rank-sum tests compared them across groups. A multivariable Gamma generalized linear model with a log link was used for the adjusted analysis.

Price ratios differed across four therapeutic areas that each had at least five observations, with P < 0.001. Fixed-dose products in the negotiation catalog had lower median ratios than those in the regular catalog, 0.51 versus 1.12, also with P < 0.001. In unadjusted comparisons, ratios were higher when at least one free-equivalent component was included in volume-based procurement: 1.12 compared with 0.63, with P = 0.003. The adjusted analysis included 48 groups. Therapeutic area remained associated with the price ratio (P = 0.023), and negotiation-catalog fixed-dose combinations continued to have lower ratios than regular-catalog products (P < 0.001). Volume-based procurement status was not independently associated with the ratio after adjustment (P = 0.431).

The study describes relationships among unit prices for reimbursed fixed-dose combinations with identifiable comparators and available price data. Because it was a cross-sectional analysis, the results do not establish what caused the differences or whether they affect treatment outcomes, and the measures do not test the clinical effects of fixed-dose combinations. The authors concluded that the product-level price relationships varied by therapeutic area and formulary category, with the unadjusted volume-based procurement difference not persisting after adjustment.

Subject of Research: Cross-sectional analysis of fixed-dose and free-equivalent medicine prices in China’s National Reimbursement Drug List

Article Title: Relationship between prices of fixed-dose and free-equivalent combination: a survey of medicines in China's National Reimbursement Drug List

Article References: Feng, Y., Li, W., Wang, J., Ding, J., & Jin, C. (2026). Relationship between prices of fixed-dose and free-equivalent combination: a survey of medicines in China's National Reimbursement Drug List. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15601-z

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15601-z

Keywords: fixed-dose combinations, free-equivalent combinations, medicine prices, National Reimbursement Drug List, China, therapeutic areas, reimbursement category, volume-based procurement, health services research, Relationship, between, prices