Purpose <p>Lung cancer remains the leading cause of cancer-related morbidity and mortality in China, yet systemic inequalities in drug accessibility persist. The present study aimed to investigate the availability and affordability of 23 anticancer drugs for lung cancer in Central China.</p> Methods <p>A cross-sectional study was conducted from December 2022 to July 2023 across 62 hospitals in Central China using the WHO/HAI standardized methodology. Drug availability was defined as the proportion of hospitals stocking medicines on the survey day, while affordability was assessed as treatment costs ≤ 20% of household income. Supplemental procurement time (SPT) measuring restocking time for unavailable drugs, was introduced to evaluate availability dynamics.</p> Results <p>Only 34.8% of drugs met WHO availability thresholds (&gt;80%). Traditional chemotherapies (e.g., cisplatin, gemcitabine) showed high availability (&gt; 80% in tertiary hospitals) but remained unaffordable for low-income households (e.g., docetaxel originator brands (OBs): 288.62-374.27% of monthly income). Unlike conventional availability metrics, our SPT index revealed rapid restocking (≤ 72&#xa0;h) for 69.4% of anlotinib-a dynamic accessibility dimension previously unmeasured in oncology drug studies. Whereas crizotinib faced delays (&gt; 1 month) in 43.55% of hospitals, undetected by traditional methods.</p> Conclusion <p>We found that the availability of anticancer drugs for lung cancer is extremely unequal, and only a few medicines were considered affordable. Further efforts should be made to sufficiently and equally benefit patients with cancer.</p>