In recent years there is a huge leap of pharma industry towards rare diseases and orphan drug developments due to the great support from regulatory authorities such as faster approval timelines, supportive regulatory frameworks, financial incentives, and many more. Currently, large pharmaceutical companies are extremely active in the orphan drugs market. Novartis, GSK, Roche, and Pfizer are the largest orphan drug companies.
A supportive regulatory framework was established long back in the USA (1983), Japan (1993) and Europe (2000), in order to treat patients and support pharma industries working on rare diseases and orphan drugs.
Check out the first article is this series Rare Diseases: Regulatory Incentives for Development of Orphan Drugs – US & EU
Now there is an increasing trend towards orphan drug developments worldwide and many other regulatory authorities are working on, coming back with new frameworks in order to establish great support to orphan drug developments in rare diseases.
In the previous article series, we have discussed regulatory benefits in US, Europe, Japan, and Australia, now in this article, we will be looking through the regulatory aspects and new regulatory changes in orphan drugs for rare diseases in China, India, Russia, and South Korea.
Check out the second article is this series Rare Diseases: Regulatory Incentives for Development of Orphan Drugs – Japan & Australia
China – Orphan drug regulations
A disease is considered to be rare if the prevalence is <1 patient per 500,000 people or a neonatal morbidity of < 1 patient per 10,000 people.
China is currently suffering from a shortage of treatments for rare disease and of the 44 globally available therapies for rare diseases, only 19 are currently marketed in China, and of these 19, are priced outreach to the average Chinese patient.
On May 22, 2018, the new NHC (National Health Commission), along with the CNDA (China National Drug Administration) and three other agencies jointly published the first edition of the Rare Disease List (RDL) which includes 121 diseases and is considered as a huge milestone for regulation in rare diseases.
In China, there are no proper guidelines and regulations for rare diseases, however, there are some special considerations such as
- Overseas data acceptance
- The state council issued an opinion that orphan drugs and drugs for unmet medical needs can be approved with overseas clinical data only if certain conditions are met, and that the CNDA shall review the application within 3 and 6 months, respectively. This not only adds a clear review timeline to the regulatory pathway, but it also promises to accelerate approval significantly.
- The main takeaway is that a rare disease drug can gain approval with overseas clinical data, regardless of whether the drug has been approved in other countries or not.
- Tax benefits
- China has announced a plan to slash the Value Added Tax (VAT) on 21 rare disease therapies and four active pharmaceutical ingredients, dropping it by 80% in a bid to stimulate the domestic rare disease therapy market and drop the prices of the therapies.
Criteria for orphan drug
- The disease has a low prevalence or incidence in China.
- There is a significant impact on the patient or family due to the disease.
- There is a clear method of diagnosis.
- The disease is treatable and intervention is feasible and economically accessible.
- There is no currently available treatment but the disease is being investigated under a government-funded research program. 
Russia – Orphan drug regulations
Diseases are considered to be rare diseases if they have a prevalence of not more than 10 cases per 100 thousand people.
Russian Ministry of Healthcare on the basis of statistical data maintains a list of rare diseases on its official website.
- Provision for clinical trial data: Clause 3.1 art. 26 of the law on drug circulation with respect to orphan drugs specifies provisions to provide the results of clinical studies of orphan drugs performed outside of the Russian Federation (provided they are in accordance with standards similar to Russian good laboratory practice and good clinical practice)
- The accelerated procedure of examination: Examination of documents in the registration dossiers, quality control and expertise of benefit-risk balance for the purpose of state registration of orphan drug is carried out by the decision of the Russian Ministry of Healthcare pursuant to the applicant’s application within a period not exceeding 80 business days (whereas in general examination takes 110 business days). 
Read more about Rare Diseases: Clinical Trials & Drug Development
India – Orphan drug regulations
In India, a drug intended to treat a condition which affects not more than five lakh (500,000) persons are considered as an orphan drug.
India has started revising its orphan drug policy in order to benefit patients with a rare diseases. Provisions made for clinical development for rare diseases in New Drugs and Clinical Trials Rules, 2019. are
- Fastrack approval process and special status for orphan drugs, including a complete fee waiver for filing clinical trial.
- Provision for expeditious review process even if the drug has not completed all clinical trial phases, the sponsor or applicant may apply to the Central Licensing Authority (CLA) for expedited review.
- Waiver of local clinical study and Phase IV on the satisfaction of Central Licensing Authority (CLA).
- Financial Benefits
- No application fee is charged for conducting clinical trials for orphan drugs. 
South Korea – Orphan drug regulations
The term rare disease applies to diseases for which there are fewer than 20,000 patients and for which no appropriate treatment or substitute treatment modality is available in South Korea.
There is a gradual increase in awareness of rare diseases. A support program was initiated by the government for patients with the rare disease since 2001 and initiated its support for research in rare disease clinical trials. The Ministry of Food and Drug Safety (MFDS) announced that it would amend regulations to allow orphan drug designation on approved clinical trials.
- The amendments include
- Expand the scope of applicants for orphan drug designation
- Improve disclosure methods for by changing the designation procedure of orphans drugs
- Simplify the procedure for orphan drugs. 
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Interested in knowing more about these benefits from other countries?
Find out in the next articles in this series about incentives and support mechanisms for rare diseases in