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India’s latest essential medicines list: gaps, strengths and opportunities in evidence-based decision-making
  1. Gautam Satheesh1,
  2. M K Unnikrishnan2,
  3. Vivekanand Jha3,4,
  4. Abdul Salam3,5
  1. 1 The George Institute for Global Health, Hyderabad, India
  2. 2 NGSM Institute of Pharmaceutical Sciences, Mangalore, Karnataka, India
  3. 3 The George Institute for Global Health, University of New South Wales, New Delhi, Delhi, India
  4. 4 School of Public Health, Imperial College, London, UK
  5. 5 Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
  1. Correspondence to Gautam Satheesh, The George Institute for Global Health India, Hyderabad, India; gautamsatheesh{at}

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Essential medicines—defined by the WHO as ‘those that satisfy the priority health care needs of the population’—are meant to be always accessible within health systems, in sufficient quantities, in optimal dosage forms, of guaranteed quality and at affordable costs.1 The WHO Model Essential Medicines List (EML)1 serves as a reference for countries to design and update national EMLs to support medicine procurement, supply, manufacture, pricing and prescribing practices. In this commentary, we discuss the gaps, strengths and opportunities in evidence-based decision-making in India’s latest national EML, highlighting potential lessons for the future and for other countries.

India’s first National List of Essential Medicines (NLEM) was released in 1996, following which it has been revised four times: in 2003, 2011, 2015 and most recently in 2022,2 after a gap of 7 years. Within this gap between NLEM-2015 and NLEM-2022, the WHO revised its EML three times (every 2 years), and each revision comprised 90 modifications on average. Unlike the WHO, many countries fail to update national EMLs regularly (see figure 1), in response to changing healthcare demands, mounting scientific evidence and local disease burdens. These delays have potential implications, particularly in low resource settings, because including a medicine in the EML leads to price control, increased prescribing and consequently, improved access and affordability.

Figure 1

Revisions in the essential medicine lists of South and South-East Asian countries since 2010.

India faces a dual burden of infectious diseases and non-communicable diseases. Despite cardiometabolic conditions being the leading cause of death and disability in India—significantly affecting Indians’ most productive years—the proportion of patients receiving optimal care remains alarmingly low.3 4 Poor access to essential medicines is among the …

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  • Contributors GS and MKU conceived the idea of the commentary. GS and AS conducted the document review with inputs from VJ. GS and AS wrote the first draft of the manuscript. All authors read and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests VJ is listed as a contributor to the expert consultations on the report of the Standing National Committee on Medicines for the revision of National List of Essential Medicines. VJ has received grant funding from GSK, Baxter Healthcare, and Biocon and honoraria from Bayer, AstraZeneca, Boeringer Ingelheim, NephroPlus, and Zydus Cadilla, under the policy of all honoraria being paid to the organization.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.