Dulaglutide Enters China's National Reimbursement Drug List at 149 RMB per Dose, Price Slashed by Over 64.5%

On January 13, the Shaanxi Provincial Public Resource Trading Center issued a notice stating that, in response to corporate applications, the online listing price cap for Eli Lilly’s dulaglutide injection (1.5 mg/0.5 mL pre-filled pen, 2 pens per box) has been adjusted from RMB 840 per box to RMB 298 per box, equivalent to RMB 149 per pen. This represents a price reduction of over 64.5%!

Dulaglutide is a once-weekly long-acting GLP-1 receptor agonist developed by Eli Lilly and Company. It was approved by the FDA in September 2014 for the treatment of type 2 diabetes and subsequently launched in multiple regions, including the European Union and Japan. In February 2019, it received approval from the National Medical Products Administration (NMPA) for entry into the Chinese market. It is indicated for glycemic control in adults with type 2 diabetes, including as monotherapy or in patients who have not achieved adequate glycemic control with metformin and/or sulfonylurea therapy.

GLP-1 is an "incretin" naturally secreted by the mucosa of the human gastrointestinal tract. GLP-1 receptor agonist hypoglycemic agents are currently among the best-selling antidiabetic drugs. Their advantages include a significantly lower incidence of hypoglycemic events compared to insulin, reduced food intake, delayed gastric emptying, which aids in weight control, and protection of pancreatic β-cell function.

The dulaglutide molecule is produced through mammalian cell culture using biomolecular engineering techniques. Its molecular structure consists of three components: a GLP-1 analog, a linker peptide, and a modified IgG4 Fc fragment. The half-life can reach up to 4.7 days, allowing for once-weekly administration, which is closely related to its molecular structure.

Currently, there are seven GLP-1 receptor agonists approved for marketing in China. Three of them are short-acting products: exenatide, benaglutide, and lixisenatide. The other four are long-acting products, including liraglutide (long-acting), exenatide microspheres for injection, dulaglutide, and pegylated loxenatide (ultra-long-acting).

The Pharmaceutical Database (PDB) shows that in sample hospitals in China, short-acting GLP-1 receptor agonists hold a dominant market share due to their earlier market launch. Among them, liraglutide injection exhibited the fastest growth in market share, rising from 37% in 2012 to 91% in the first three quarters of 2020.

Comprehensive Drug Database (PDB)

Previously, liraglutide, lixisenatide, and exenatide had been included in the National Reimbursement Drug List (NRDL). In the 2020 edition of the NRDL, dulaglutide, polyethylene glycol loxenatide, and benaglutide were successfully incorporated through price negotiations. Thus, all three long-acting GLP-1 receptor agonists have been included in the NRDL.

Dulaglutide was approved in China in February 2019. Its original price was RMB 420 per pen (1.5 mg/0.5 mL, pre-filled injection pen), administered once weekly. Following the latest round of national medical insurance negotiations, the price has been reduced to RMB 149 per pen (1.5 mg/0.5 mL, pre-filled injection pen). Based on this, the annual cost for a typical patient (52 weeks) is RMB 7,769. With a reimbursement rate of 70%, the out-of-pocket expense is only RMB 2,331 per year, equivalent to RMB 149 per month.

For similar products, domestic companies have not remained idle in the face of Eli Lilly’s significant price cuts.

Just two days ago, the drug procurement centers in Shaanxi and Jilin provinces separately issued announcements adjusting the online listing price cap for Jiangsu Hansoh’s polyethylene glycol loxenatide injection (0.5 mL, 0.2 mg per vial) from RMB 395 per vial to RMB 187 per vial.

Products such as dulaglutide injection and pegylated loxenatide injection have just passed the negotiations for the 2020 National Reimbursement Drug List (NRDL). As required, the new NRDL will be officially implemented on March 1. These products are among the first to undergo price reductions, reflecting highly competitive market strategies.

In recent years, it has become increasingly common for companies to proactively reduce product prices. On one hand, businesses often lower prices in response to shifts in competitors’ pricing, engaging in price adjustments to compete for market share. On the other hand, companies may also initiate price cuts to seize market share early, establish a first-mover advantage, and create barriers for later entrants.

With less than two months remaining before the new National Reimbursement Drug List (NRDL) takes effect, it is normal for pharmaceutical companies to take the initiative in reducing prices. However, as these drugs are still classified as self-pay medications and are not eligible for reimbursement at this stage, their ability to capture market share remains to be seen.