The year 2018 was epic for the Japanese pharmaceutical industry, largely because of the fundamental National Health Insurance (NHI) pricing reforms implemented in April, says Tosh Nagate at e-Projection K.K. The repercussions of this change in policy are yet to be fully felt as of the beginning of 2019; however, some of the cautionary signs can already be seen. For example, some domestic companies exited the market last year because of the unattractive prospects. This was unprecedented, particularly for a full-fledged domestic pharma company and it is difficult to imagine that these will be the only ones, with more moves expected in the coming months.