At 200 RMB per pill, a homegrown “flu wonder drug” is struggling to gain traction

A 100–300 RMB “flu miracle drug” is no longer synonymous with baloxavir marboxil (Xofluza).

In 2025, three domestically developed new influenza antivirals—often nicknamed the “Zhong Nanshan edition” or “Zhang Wenhong edition”—entered the market one after another, breaking China’s long-standing gap in original, innovative flu medicines.

These newcomers have pushed the efficacy narrative to a new level. Some highlight “full-body symptom relief in 18 hours,” while others mirror baloxavir’s mechanism and position themselves as a single, once-only oral dose for the entire course—claiming fever reduction and detoxification within one day, with average fever resolution shortened to around 22 hours.

Pricing ranges from roughly 180 RMB to 320 RMB per course, close to baloxavir’s online retail pricing.

Still, replacing an established “star drug” is far from easy.

When reporters called multiple pharmacies to ask about these new products, some pharmacists sounded uncertain—then asked back if the customer meant baloxavir instead.

For years in China, the frontline influenza drug was mainly oseltamivir. After baloxavir was approved in 2021, it gradually became the public’s go-to “flu wonder drug.”

Data from Zhongkang Technology shows that from launch through October 2025, the combined sales of these domestic new flu drugs totaled less than 10 million RMB. In contrast, from January to October alone, oseltamivir and baloxavir together generated nearly 8.5 billion RMB in sales.

Industry insiders note that many of these flu drugs follow a fast-follow R&D approach, which can lead to product similarity. With more mechanism-adjacent domestic candidates still waiting for approval and potentially entering the market next year, the commercialization window for local manufacturers is getting shorter.

“No One Walks Into a Pharmacy Asking for the New Drug”

So far, three domestic flu antivirals have reached commercialization: Mashulashavir tablets, Onradivir tablets, and Maseloxavir tablets. They were approved in March, May, and July of 2025, respectively.

The lead investigators for their Phase III trials included prominent clinicians: Cao Bin (Vice President of China-Japan Friendship Hospital), Academician Zhong Nanshan, and Zhang Wenhong (Director of Infectious Diseases at Huashan Hospital, Fudan University). Related clinical studies were published in internationally recognized journals in their fields.

Yet for most everyday consumers, these names remain unfamiliar.

In mid-December, a reporter from Economic Observer visited several pharmacy chains in Beijing carrying a note with the three drug names. Store staff struggled to pronounce the names, and many replied with the same question: “Do you mean Xofluza?”

Some pharmacies had sold Mashulashavir via Meituan, but monthly sales were only about 1–5 orders. In offline stores, several locations reported zero sales.

“No one comes in asking for this new drug. Patients are still looking for oseltamivir and Xofluza,” one store manager said.

On her store shelf sat two stacks of Mashulashavir—still bundled with rubber bands. She explained that the branch accidentally requested the new drug after mistaking it for baloxavir, so they stocked 10 boxes and sold only one online.

In her view, “If pharmacies want to sell a new prescription drug, doctors in hospitals need to know it first and recommend it to patients. What patients recognize on their own are mostly the old drugs. If doctors don’t mention it, patients won’t know. You can’t rely on pharmacies alone to move a new drug.”

Several physicians told Economic Observer that based on existing clinical evidence, domestic new flu antivirals are not inferior to oseltamivir or baloxavir.

However, their approved patient populations are more limited. For influenza treatment, oseltamivir can be used for patients aged 1 year and above, while baloxavir is approved for 5 years and above. By comparison, the domestic newcomers are mainly approved for 12 years and above, or adults. For influenza prevention, only oseltamivir is currently indicated.

Hu Xin, Chief Pharmacist and Director at Beijing Hospital’s Pharmacy Department, noted that research on use in patients with renal impairment remains insufficient across the three domestic drugs. Some also lack clinical studies in patients under 18 or over 65, meaning physicians must be more cautious when prescribing for these groups.

Li Tongzeng, Chief Physician at Beijing You’an Hospital (Respiratory & Infectious Diseases), also pointed out that, according to current labels, older drugs like oseltamivir and baloxavir can be used for patients at high risk of influenza complications, while the new drugs generally cannot—at least not yet.

Another key barrier is reimbursement. In the November 2025 national medical insurance negotiations, Mashulashavir and Onradivir were included for reimbursement, with insurance pricing to take effect in 2026.

Li Tongzeng said the updated reimbursement list has not yet been implemented, and most hospitals in Beijing have not started purchasing these new influenza drugs. “Whether a hospital brings in a new drug depends mainly on clinical demand. If a similar product doesn’t have a clear advantage in efficacy or price, it’s hard to get into hospitals.”

Today, oseltamivir has been included in the national volume-based procurement program, bringing hospital pricing to around 20 RMB per box, which significantly boosts accessibility. After baloxavir entered insurance coverage, the price for 20 mg × 2 tablets/box dropped from 498 RMB to 222.36 RMB. The insurance prices for the newly covered domestic flu drugs have not yet been announced.

“If it cures one day faster, or reduces fever two hours earlier, but costs another 100–200 RMB, some patients may feel it’s not worth it,” Li said.

So far, the two traditional sales pillars—hospitals and pharmacies—have contributed only modestly to new-drug revenue.

Zhongkang Technology data shows that from launch through October 2025, Mashulashavir and Onradivir each recorded sales in the “millions of RMB” range. For Mashulashavir, about 38% of sales came from hospitals and 5% from pharmacies; for Onradivir, only 7% came from hospitals and 2% from pharmacies.

That structure contrasts sharply with legacy drugs. From January to October 2025, oseltamivir and baloxavir generated about 5.6 billion RMB and 2.869 billion RMB in sales, respectively—of which hospitals and pharmacies together contributed 60%–70%.

The E-Commerce Playbook for Domestic Brands

E-commerce is emerging as the commercialization fulcrum for these new flu drugs.

A representative from Qingfeng Pharmaceuticals said hospitals remain their core channel, but the company also places strong emphasis on pharmacies and e-commerce platforms.

All three domestic drugs went live on platforms such as JD Health (06618.HK) within 1–3 months after approval. Still, each manufacturer has adopted a different online strategy.

Mashulashavir has leaned into a “domestic brand” identity. Because its packaging is entirely green, it has earned the nickname “the little green box” on e-commerce platforms. The manufacturer says the color reflects a uniquely Chinese aesthetic, and as China’s first next-generation anti-influenza PA inhibitor, they hope patients feel cultural confidence and pride when receiving it.

Onradivir has a dedicated promotional page within the JD app, titled along the lines of “The ‘Zhong Nanshan edition’ domestic new drug has arrived,” emphasizing “led by Academician Zhong Nanshan.”

Maseloxavir has used bundle-driven traffic: pairing with “flu prevention and treatment kits” that may include rapid test kits, original-brand ibuprofen, and other products from the same manufacturer, such as Pudilan oral liquid.

According to Zhongkang Technology, from launch through October 2025, e-commerce accounted for the largest share of sales for Mashulashavir and Onradivir—about 51.65% and 84.68%, respectively.

“Prescription drugs can’t be advertised, but e-commerce platforms can both sell and showcase products. That gives real value in communicating core benefits directly to patients. Many companies now choose an online-first launch so patient education and sales are integrated,” said Su Caihua, Vice President at Zhongkang Technology.

But patient education online can also be fragile.

One patient told Economic Observer that after buying Onradivir on Meituan, her fever rose instead of falling—because she mistakenly assumed it worked like baloxavir, where one tablet is enough. In reality, Onradivir’s recommended dosing is once daily, three tablets per dose.

A Potential Breakthrough: Lower Resistance Risk

So where is the true differentiation versus legacy drugs?

Manufacturers are converging on one shared message: lower resistance risk.

Li Tongzeng explained that in anti-infective treatment, “drug resistance” means viral strains may become less sensitive to older drugs. If resistant strains emerge against legacy therapies, new drugs could become valuable alternatives.

On December 2, Lu Hongzhou, President of Shenzhen Third People’s Hospital, told Red Star News that resistance had already been observed with commonly used drugs like oseltamivir and baloxavir, and that under such circumstances Onradivir remained strongly effective. The phrase “oseltamivir resistance has emerged” later trended on Weibo.

However, current evidence suggests resistance rates in China remain relatively low.

According to the National Influenza Center’s December 17 data, analysis of selected influenza virus strains collected since March 31, 2025 found that among A(H1N1)pdm09 strains, 3.8% showed reduced or highly reduced sensitivity to neuraminidase inhibitors—primarily oseltamivir, zanamivir, and peramivir.

The same data indicated that all A(H3N2) strains remained sensitive to neuraminidase inhibitors. A(H3N2) has been the dominant strain during China’s late-2025 flu season.

In addition, all tested A(H1N1)pdm09 and A(H3N2) strains were sensitive to polymerase inhibitors. Baloxavir is a polymerase inhibitor.

Li added that baloxavir was launched earlier in Japan and has accumulated more resistance reports there. In China, widespread use has only been underway for the past two to three years. Whether resistance strains will increase with broader adoption remains a question that requires close, ongoing monitoring.