Household cost of treating pregnancy-related complications in an urban setting: a study at the Korle Bu teaching hospital, Ghana.

Cancer constitutes a significant public health challenge in both developed and developing nations. According to the 2022 National Cancer Report issued by the National Cancer Center of China, the country reported 4.064 million new cancer cases, with a world-standardized incidence rate of 186.46 per 100,000 individuals []. However, current treatment regimens for many cancers frequently fail to contain disease progression, underscoring the paramount importance of innovative anticancer drugs []. The financial burden of cancer treatment appears catastrophic for Chinese patients, with approximately half resorting to borrowing or incurring debt, and 10% reporting foregoing medical care due to cost concerns []. Many patients cannot afford targeted anticancer therapies []. To improve the utilization and accessibility of innovative drugs, the Chinese government introduced the National Drug Price Negotiation (NDPN) policy in 2016 []. This national-level negotiation mechanism between the central government and pharmaceutical companies primarily aims to reduce the prices of innovative drugs with high clinical value []. Pharmaceutical companies aspire to secure entry into the National Reimbursement Drug List (NRDL) by offering substantial price reductions, which can swiftly amplify their market share in China through volume gains at the expense of margins. As of January 2023, the NRDL included 430 negotiated drugs, a large proportion of which were anticancer drugs. This policy logic is not unique to China. Drug price negotiation policies have also been adopted in other settings, including Europe and the United States [], based on the expectation that reimbursement listing can increase sales volume and market share despite lower unit prices. Consequently, patients may gain access to reimbursed drugs, potentially improving affordability and the cost-effectiveness of treatment. To improve access to negotiated drugs, China implemented the “dual-channel” system in 2021, enabling dispensing through both designated hospitals and pharmacies []. Previously, most anticancer drugs followed a “hospital-first, then reimbursement” path, allowing sufficient time for market promotion, clinical experience accumulation, expert endorsement, and widespread use. However, the recent reform reversed this sequence to “reimbursement-first, then hospital,” which placed greater pressure on hospitals to achieve timely formulary entry and rapid clinical adoption. In practice, some negotiated drugs encounter difficulties in hospital entry, resulting in delayed supply. Recognizing pharmacies’ broad geographic coverage, market responsiveness, and service flexibility, policymakers positioned pharmacies as a complement to designated medical institutions. To address the “hospital-entry challenge,” pharmacies were integrated into the negotiated drug supply network alongside medical institutions, forming a dual-channel reimbursement and dispensing system that improved drug accessibility.