UBS expert call focuses on China's insomnia drug market: DORA's long-term potential is clear, but pricing and hospital access constraints remain key bottlenecks

Overview

This report is a summary of an expert call hosted by UBS on April 22, 2026, featuring Dr. Liu from the Department of Neurology at Shanghai Pudong New Area People's Hospital. The topic was trends in China's sleep disorder drug market. The discussion focused on insomnia prevalence and standard treatment pathways, comparisons among different insomnia drugs, and the clinical feedback and commercialization constraints of DORA drugs.

Core views

The expert is overall positive on the DORA drug class because it is more suitable than traditional BZDs for long-term insomnia management, and no significant signals of dependence or cognitive impairment were observed in clinical trials. However, DORA currently costs about Rmb18-20/day, and hospital-side drug-sales ratio controls may mean short-term in-hospital sales lag those of out-of-hospital pharmacies or online channels.

Analysis framework

The report is based on an expert call Q&A and uses a clinician's perspective to analyze insomnia patient segments, treatment pathways, criteria for drug selection, the positioning differences between DORA, BZD, and non-BZD drugs, and channel penetration paths in light of hospital drug management constraints.

Methodology notes

• Expert interviewExpert call summary

  Obtain frontline feedback on disease management and prescribing behavior through Q&A with clinical experts.

  The report content comes from a call with a chief neurologist. UBS notes that the expert's views do not necessarily represent UBS's views, and the summary was edited for clarity.

• Treatment pathway analysisStandard insomnia treatment pathway

  Lifestyle management, behavioral therapy, pharmacotherapy, and supportive therapy together form comprehensive insomnia management.

  The expert emphasized that regular sleep schedules and psychological-behavioral interventions are foundational, while medications are usually used for rapid symptom relief alongside subsequent maintenance and tapering.

Asset mapping & comparison

Structured mapping from thesis to named assets (strengths, weaknesses, peers, risks).

• DORA drug class

  core incremental treatment direction

  Strengths

  Good safety and tolerability, with no obvious signals of dependence or cognitive impairment observed, supporting long-term insomnia management.

  Weaknesses

  Relatively expensive and currently difficult to fully replace low-cost BZDs or non-BZD sedative-hypnotics.

  Comparison

  Compared with BZDs, DORA is more suitable for long-term management; compared with short-acting zolpidem-class drugs, DORA can be used for more complex dimensions of insomnia.

  Risks

  If price cuts fall short of expectations, hospital access is slow, or patient willingness to pay is insufficient, penetration gains may be limited.

• lemborexant

  DORA subcategory drug

  Strengths

  Relatively rapid onset, with a duration of action of about 8-10 hours.

  Weaknesses

  Still faces the common pricing and channel constraints of the DORA class.

  Comparison

  More suitable for patients mainly troubled by difficulty falling asleep.

  Risks

  If it lacks a cost advantage versus existing short-acting drugs, substitution may proceed slowly.

• daridorexant

  DORA subcategory drug

  Strengths

  Longer duration of action.

  Weaknesses

  Recently launched and mainly available through out-of-hospital pharmacies or online channels, with limited in-hospital introduction so far.

  Comparison

  More suitable for patients with difficulty maintaining sleep or insufficient sleep quality.

  Risks

  Hospitals may delay introduction because of pricing and drug-sales ratio pressure.

• BZD drugs

  traditional short-term treatment option

  Strengths

  Can rapidly relieve short-term insomnia and difficulty falling asleep; commonly used drugs include diazepam, lorazepam, estazolam, and alprazolam.

  Weaknesses

  Carry risks of dependence, memory impairment, and long-term cognitive effects, so they should be used cautiously in the elderly and children.

  Comparison

  More suitable for short-term or transitional use and not appropriate as the core long-term management solution.

  Risks

  Prescriptions are restricted under Class II psychotropic drug management, and the risk of overuse is relatively high.

• Out-of-hospital pharmacies and online channels

  potential main scaling channels for DORA

  Strengths

  If there are no strict prescription restrictions, out-of-hospital channels may promote DORA more easily than hospitals.

  Weaknesses

  Still affected by pricing and patient affordability.

  Comparison

  Compared with hospitals, out-of-hospital channels are less directly constrained by drug-sales ratio indicators.

  Risks

  If regulation, prescription compliance, or online drug sales policies tighten, channel expansion may be affected.

Key data

• Prevalence of insomnia symptoms in Chinaabout 30-40%The expert cited figures from the 2019 Chinese guideline for the comprehensive prevention and treatment of insomnia.
• Proportion of chronic insomnia in the populationabout 10% of the general adult populationAmong those with insomnia symptoms, chronic insomnia accounts for about one-quarter to one-third.
• Prevalence of sleep disorders in the elderlyabout 40-50%The incidence of sleep disorders rises significantly after age 60, and women are more prone to insomnia.
• Daily treatment cost of DORAabout Rmb18-20/dayHigh pricing is the main challenge for hospital access and improved penetration.
• Target ratio for in-hospital drug salesbelow 39-42%The expert's department has drug-sales ratio targets, and high-priced DORA may increase hospital resistance to introduction.
• BZD prescription durationusually no more than 1 week, up to 2 weeks with physician handwritten signaturePrescriptions for Class II psychotropic drugs are subject to strict restrictions.
• Adjustment cycle for chronic insomniaabout 3 months to half a yearAcute insomnia can usually be relieved after a single prescription, while chronic insomnia often accompanies comorbidities and requires gradual adjustment.

Impact & implications

If DORA prices decline or payment accessibility improves, it could gradually replace some BZDs, zolpidem-class drugs, or eszopiclone from out-of-hospital channels and in early-line treatment scenarios, especially for patients needing long-term management or those with difficulty falling asleep or maintaining sleep. However, near-term volume growth still depends on pricing, hospital access, prescription restrictions, and patient affordability.

Risks

• DORA's high price may lead to insufficient patient access and willingness to pay.
• Hospital drug-sales ratio controls may cause DORA access and volume growth to be slower than expected.
• Long-term BZD use carries dependence, memory impairment, and cognitive risks, limiting its role in long-term treatment.
• Insomnia patients often have comorbidities such as anxiety, depression, hyperthyroidism, and Sjogren's syndrome, leading to significant differences in treatment duration and efficacy.
• China's healthcare sector also faces risks from centralized procurement price cuts, intensifying competition, medical insurance negotiated prices coming in below expectations, slower-than-expected consumption recovery, tighter regulation, and geopolitical risks.

What to watch

• Progress on DORA price cuts or coverage by medical insurance and commercial payment.
• The pace of hospital access for daridorexant and lemborexant.
• The contribution of out-of-hospital pharmacies and online channels to DORA sales.
• Whether DORA can replace some BZD, zopiclone, eszopiclone, or zolpidem-class drugs.
• Long-term follow-up rates, treatment duration, and post-discontinuation relapse among chronic insomnia patients.