Scope: professional education and governance analysis, not patient-specific medical, reimbursement, or legal advice. Translations of China-specific policy terms are unofficial.
Executive takeaways
- The 2025 list took effect on 1 January 2026; consultation documents for the 2026 adjustment are not final rules.
- List inclusion does not mean identical reimbursement for every indication, provider, or patient.
- Hospitals must align the list, label, benefit restriction, formulary access, and clinical pathway.
The list is a governed cycle, not a static table
Adjustment proceeds through application, formal review, expert assessment, negotiation or bidding, publication, and agreement management. The 2025 basic list added 114 medicines and removed 29, effective 1 January 2026. Any later-year proposal must be labelled by its actual status.
Four real access gates
After national inclusion, users still need the benefit restriction, agreement and payment terms, pooling-region rules, hospital formulary access, and prescribing authority. Final patient liability also depends on deductible, reimbursement ratio, care setting, and individual eligibility.
- Pharmacy: synchronise national changes and hospital selection.
- Clinical: align indication, benefit restriction, and record evidence.
- Payer office: maintain codes, claim fields, and traceability data.
- Patient communication: do not promise a fixed reimbursement amount; provide a verifiable local route.
DRG/DIP and appropriate medicine use
Bundled payment increases cost pressure but must not turn the case payment into a denial of necessary medicines. The legitimate response is evidence-based selection, pharmaceutical care, exceptional-case pathways, and real-world evaluation—not externalising covered care to patient self-pay.
Cross-system control table
| Clinical event | Payment context | Review signal | Hospital action |
|---|---|---|---|
| Care, medicine, device, or documentation changes | Separate FFS, DRG/DIP, and fixed-payment effects | Reconcile orders, records, charges, claims, and outcomes | Verify facts, correct records and rules, document remediation |
Updated 2026-07-06. Always verify the current national and local documents before operational use.