One morning in mid-November, Shanghai office worker A Liang woke up with a tight throat and a wave of fatigue. By noon, a low fever had set in, a feeling entirely different from the mild cold she had just recovered from days earlier. That was when she realized she had likely come down with the flu.
The 2025 winter flu season arrived nearly a month early. At a November 10 press briefing, the National Administration of Disease Control and Prevention said flu activity was rising nationwide and that this year’s autumn and winter peak would likely occur from late December through early January.
Demand for flu medication is climbing rapidly. Data from Meituan Maiyao shows that since November, orders for influenza A and B treatments have more than doubled, with northern cities such as Harbin, Hohhot, and Taiyuan reporting increases above 150%.
Both long-established treatments and newer drugs are surging. Orders for oseltamivir phosphate granules on Meituan Maiyao are up more than 85%, while orders for baloxavir marboxil have risen more than 110%. With several next-generation Chinese-developed flu drugs approved this year, a market long dominated by oseltamivir is becoming newly competitive.
Compared with oseltamivir, which requires twice-daily dosing over several days, this new class of antivirals emphasizes convenience and faster symptom relief. Their prices, however, can be up to ten times higher, and despite limited brand recognition, they have already entered a fierce race.
Single-dose flu treatments
Influenza is one of China’s most common respiratory infections, with up to 100 million cases annually. The virus’s structure and infection pathway are well understood, making drug development relatively straightforward and supporting a market worth tens of billions of RMB. The flu-specific antiviral market alone exceeds RMB 10 billion (USD 1.4 billion).
This scale may explain the wave of pharmaceutical companies entering the segment.
A decade ago, many patients did not distinguish between a cold and the flu, often opting for cold medicines or even antibiotics and injections for flu-like symptoms.
“Public awareness is much better now. People understand the flu can lead to severe complications like pneumonia or white lungs. It has become easier to convince patients to use antivirals,” said Li Tongzeng, chief physician at Beijing Youan Hospital.
Oseltamivir shifted the field by introducing a mechanism that traps the virus inside host cells, preventing release and allowing the immune system to clear the infection naturally. The drug generated 9.8 billion RMB in China in 2023, topping the flu category.
But more than twenty years after launch, oseltamivir has been pulled into national centralized procurement, which sharply cut prices and margins. Its short half-life of six to ten hours also requires twice-daily dosing for five days. Both factors have pushed drugmakers toward next-generation options.
Baloxavir marboxil, introduced by Roche in 2021 and marketed in China as Xofluza, is the most prominent. It inhibits the viral PA protein, preventing replication at the source and covering influenza A, influenza B, and resistant strains. With a half-life near 100 hours, it can halt viral shedding within 48 hours and requires only a single dose, improving treatment completion rates.
Xofluza was added to China’s national insurance list in its first year, prompting rapid growth. PDB data shows domestic sales reached RMB 630 million (USD 88.2 million) in 2023, nearly eight times the previous year.
Chinese companies have been racing to develop their own PA-targeted drugs. While several firms obtained approvals for baloxavir generics, patent restrictions have stalled production. Domestic innovations, however, are advancing quickly. Qingfeng Pharmaceutical and Jumpcan Pharmaceutical already have products on the market. Simcere’s rademikibart and Joincare’s Pixavir marboxil are at the new drug application stage.
Last winter’s Xofluza shortages boosted public awareness of single-dose antivirals, but high costs and limited familiarity have kept penetration low. A small survey by Qingfeng Kerui retail marketing director Xie Weibin found that fewer than 5% of confirmed flu patients chose PA-targeted drugs, which he believes shows substantial room for growth.
When old and new players compete
Efficacy may open the door for next-generation drugs, but commercial success hinges on price, distribution, and broader market dynamics.
After centralized procurement, oseltamivir products typically sell for around RMB 20 (USD 2.8), with some pediatric formulations priced below RMB 18 (USD 2.5).
New PA inhibitors, by contrast, often debut above RMB 300 (USD 42). Even after insurance negotiations, Xofluza retails for around RMB 230 (USD 32.2). Some sellers dropped prices to under RMB 200 (USD 28) as flu demand rose, but the gap remains nearly tenfold.
That gap has produced clear regional and demographic splits. Xofluza sees stronger uptake in Beijing, Shanghai, and coastal provinces such as Jiangsu and Zhejiang, while inland regions still rely heavily on oseltamivir. Older adults typically choose oseltamivir, while younger patients opt for the convenience of Xofluza. And because Xofluza is not approved for children under five, pediatrics still depend on oseltamivir.
Industry insiders expect prices for PA-targeted drugs to fall over the next three to five years as more manufacturers enter the market and insurance talks deepen, paving the way for wider adoption.
Flu drugs are often needed urgently, so they naturally fit online retail channels. E-commerce platforms are therefore expanding flu care offerings that integrate home testing, telemedicine, and rapid delivery. But regulatory constraints mean prescription drug marketing must rely on academic outreach, such as training pharmacy staff or supporting physician-led health education.
The competitive landscape is clearly shifting. Drugmakers are trying to make single-dose treatments a new prescribing habit rather than a premium niche, and that will require sustained education. As for domestic companies, this winter marks the first major test in that effort.
KrASIA Connection features translated and adapted content that was originally published by 36Kr. This article was written by Hu Xiangyun for 36Kr.