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Introduction Drug accessibility is a core challenge facing global public health systems, with financing costs directly affecting drug prices through cost-plus pricing mechanisms. This study aims to examine how digital transformation influences pharmaceutical companies' financing costs by promoting green certification and green finance availability, and to explore the heterogeneous effects of essential drug enterprises and their public health significance. Methods Based on 1,216 observations from 152 A-share listed pharmaceutical manufacturing companies in China from 2016–2023, this study employs fixed-effects panel data models to test the impact of digital transformation on financing costs, uses Bootstrap methods to test chain mediation effects, and controls for endogeneity through instrumental variable methods and propensity score matching-difference-in-differences approaches. Results Digital transformation significantly increases the probability of enterprises obtaining green certification (β = 0.079, p 0.01), green certification significantly promotes green finance availability (β = 0.134, p 0.01), and green finance significantly reduces financing costs by approximately 48.7 basis points (β = −0.487, p 0.01). Mediation effect analysis shows that the chain mediation effect accounts for 34.2% of the total effect. The effect of essential drug enterprises reducing financing costs through digital transformation is 1.9 times that of non-essential drug enterprises (−0.051 vs. −0.027, p 0.05). Mechanism testing indicates that information asymmetry mitigation and risk premium reduction explain 39% and 53% of the total effect, respectively. Discussion Digital transformation significantly reduces pharmaceutical companies' financing costs through the chain mediation of green certification and green finance, with the effect being more pronounced for essential drug enterprises. The reduction in financing costs may create room for price adjustment. Under China's essential drug price regulation system, cost savings could potentially be transmitted to essential drug prices, which has theoretical implications for improving drug accessibility and promoting health equity. It is recommended to improve the green finance standard system, strengthen differentiated policy support for essential drug enterprises, and establish a linkage mechanism between financing costs and drug prices.
Huang et al. (Fri,) studied this question.