China’s Insurance List Covers Endangered-Wildlife Drugs, Defying Own Ban

China’s revised national medical-insurance drug list, effective January 1, 2025, broadens coverage to 3,253 approved medicines, including nearly 50 traditional remedies derived from endangered animal species. This has provoked concern among environmental groups, who argue that the inclusion of these remedies contradicts Beijing’s own conservation policies and regulations. Among the species implicated are pangolins, leopards, bears, and the saiga antelope—all listed as threatened or endangered, whose use in medicine is technically prohibited by official guidelines [para. 1][para. 2][para. 3].

Specifically, the 2025 state insurance list, which determines which drugs are reimbursable by the social security fund, includes 49 traditional Chinese medicines containing materials from protected wildlife. This occurs despite the National Healthcare Security Administration’s 2020 “Interim Measures,” which stipulate that drugs containing “rare and endangered wild animal and plant medicinal materials” should be excluded from the reimbursement catalog. Public-interest environmental groups have noted that these ingredients have consistently appeared on national insurance drug lists for the past three years, without removal [para. 1][para. 2][para. 3][para. 4].

The overlap of state-funded healthcare and wildlife trade underscores a broader tension between China’s goals for ecological preservation and its commitment to supporting the traditional Chinese medicine (TCM) industry. Having a product listed in the national insurance catalog greatly boosts its market presence by lowering patient costs and ensuring high sales volumes for manufacturers. For example, the horn of the saiga antelope—a Class I protected species extinct in the wild in China—is the most prevalent endangered ingredient on the list. Seventeen drugs include antelope horn, notably Qingfei Xiaoyan Wan, with hospitals purchasing 1.8 million boxes in 2023, and total annual sales reaching 5.75 million boxes. Given official manufacturing standards, a single company could use up to two metric tons of antelope horn per year—roughly 4,000 antelopes’ worth [para. 5][para. 6][para. 7][para. 8].

A regulatory disconnect enables this situation: the Forestry and Grassland Administration manages species protection, drug regulators oversee safety and formulas, and the Healthcare Security Administration determines payment eligibility. Insurance reviews focus on clinical value and cost, not on the legality or the sourcing of raw materials. There is no systematic procedure to trace or screen the origin of endangered wildlife materials, nor are wildlife-protection experts included in the review panels [para. 9][para. 10][para. 11]. Recent tries at reform reflect this gap. After pangolins were upgraded to Class I protection in 2020, international trade was banned, and Chinese regulators recently forbade new pangolin-based drugs from entering the insurance system. However, six pangolin-based drugs remain on the 2025 list. Similarly, bear bile—a substance extracted in ways condemned by animal-welfare groups—features in 15 drugs, an increase since 2020 despite regulatory restrictions [para. 12][para. 13][para. 14].

Legal experts argue the continued inclusion undermines the authority of the medical security administration, due in part to weak enforcement mechanisms—there are no explicit penalty clauses for breaking the rules. Environmentalists and legal scholars urge a strict review for future lists, better cross-agency data sharing, and stronger audits of raw-material sourcing. While TCM advocates warn that an abrupt ban could harm patients, the consensus for a long-term solution is to accelerate development and approval of synthetic alternatives. Manufacturers like Darentang are already pursuing substitutes: researching goat horn as a replacement and conducting trials to validate efficacy. Until synthetic alternatives are fully proven and adopted, however, the insurance system continues to fuel demand for drugs derived from endangered animals [para. 15][para. 16][para. 17][para. 18][para. 19].