Angong Niuhuang Pills, Being "Cleared Out" by Hospitals

Recently, provinces such as Shandong and Shanxi have issued notices to systematically clean up medicines in the centralized procurement system that have long no transaction records.

Notably, among the list of products being delisted are well-known flagship products like Beijing Tong Ren Tang’s An Gong Niu Huang Wan.

These popular products that are never in short supply at pharmacy counters—why are they being “kicked out” of hospital procurement systems?

Image / Visual China

Policy Updates

According to an announcement from Shandong Province’s centralized drug and medical device procurement platform, medicines classified as “inactive” within the system will have their listing eligibility suspended starting March 25.

However, the policy also includes a recovery mechanism: if a medical institution has procurement needs, companies can apply to restore their listing at any time. But if there are no transactions for a month after restoration, the listing will be suspended again.

Shanxi Province has adopted even stricter measures, announcing at the beginning of this month the removal of listing eligibility for over 40 pharmaceutical manufacturing and operating companies, covering 118 drug specifications. Additionally, products from these companies will not be eligible for re-listing within two years of delisting.

The policy foundation for this cleanup traces back to August 2023, when the National Healthcare Security Administration issued the “Notice on Implementing Interconnectivity and Promoting Price Regulation of Listed Drugs.” This document first introduced the concept of “inactive zones,” referring to drugs that have no actual transaction records on procurement platforms for two or more consecutive years, with their transaction status automatically shifting to this zone.

Huang Xiangxiang, former Secretary-General of the Hunan Pharmaceutical Circulation Industry Association, told China News Weekly that the so-called “inactive zone” drugs can exist long-term not necessarily because of issues with the drugs themselves, but due to structural conflicts caused by historical legacy, corporate strategies, collective procurement impacts, clinical demand changes, and other factors.

“For example, after collective procurement, the varieties selected by public hospitals are prioritized, while non-selected specifications are marginalized. Even if companies list them, they won’t get hospital orders—it’s essentially useless,” Huang said.

He further explained that in the past, the threshold for listing was low, especially for traditional Chinese medicines, where dozens or even hundreds of approvals could exist under the same generic name or formula. Many of these products were never produced or had long been discontinued. Plus, early listing platforms lacked dynamic cleanup mechanisms, leading to an accumulation of many inactive varieties that were listed but not purchased.

It wasn’t until after the Spring Festival this year that the continuous measures taken by Shandong and Shanxi signaled that the nationwide drug listing governance work was entering a substantive phase. Industry insiders believe this can optimize the listing structure, purify price data, and ensure supply authenticity.

However, in the public directory released by Shanxi’s centralized drug procurement center, Beijing Tong Ren Tang’s well-known flagship product, An Gong Niu Huang Wan, appears prominently.

This raises questions: aren’t these products selling well? Why are they on the “delisting list”?

Is the Impact Significant?

An Gong Niu Huang Wan is considered a “super bestseller” in China’s traditional Chinese medicine market, consistently ranking as a top seller among cardiovascular and cerebrovascular Chinese patent medicines.

Data from Minyi Network shows that in 2024, among retail pharmacies in China, An Gong Niu Huang Wan led with over 4.7 billion yuan in sales, far surpassing the second-place Fufang Danshen Diwan, which had only 600 million yuan.

However, most of these sales are unrelated to hospitals. Minyi Network data indicates that in 2023, the market size for An Gong Niu Huang Wan across three major channels—physical pharmacies, online pharmacies, and hospitals—exceeded 6 billion yuan. Of this, about 5.2 billion yuan was from offline physical pharmacies, accounting for 86.7% of the total, making them the main sales channel. The public hospital channel accounted for a very small proportion, with no transaction records in procurement systems.

Among all manufacturers producing An Gong Niu Huang Wan, Tong Ren Tang holds the largest market share. According to Zhongkang CMH, Tong Ren Tang’s market share exceeds 56%. On e-commerce platforms, the price for 3g per pill ranges from 699 to 860 yuan.

Huang Xiangxiang pointed out that “inside-hospital listing and outside-hospital sales” strategies are common, especially for branded Chinese patent medicines. This approach preserves the qualification for public hospital access and maintains the product’s “medicinal” image, but does not necessarily involve actual supply or participation in collective procurement, thus avoiding price reductions that could impact profits.

Meanwhile, under the DRG/DIP payment reform, hospitals are less willing to purchase these high-priced medicines. The 2024 edition of the national medical insurance catalog limits reimbursement for An Gong Niu Huang Wan to “emergency or hospitalized patients” and explicitly states that products containing natural musk or natural bovine bile are not reimbursable, further restricting its use within hospitals.

The cleanup actions in Shandong and Shanxi send a clear policy signal: regardless of brand popularity or retail market performance, to eliminate interference with drug pricing, break down information barriers, and establish a unified, transparent pricing mechanism, drugs with no long-term transaction records will face delisting.

Industry analysts believe this may force companies to reassess their strategic positioning. Even if focusing on the outside-hospital market, they should continuously evaluate the costs of maintaining listings and adjust pricing strategies in a timely manner to avoid being “pushed out.”

“Hence, after cleanup, platforms will operate more efficiently, and high-quality products will be better supplied. But for those relying on outside-hospital high prices or non-collective procurement, it will be a real test,” Huang summarized.

As for the potential operational impact of this event, China News Weekly contacted Beijing Tong Ren Tang Group, but has not yet received a response as of press time.

Reporter: Shi Ruoxiao

(whitmanshi@163.com)

Editor: Yu Yuan