ESSENTIAL MEDICINE
Department of Pharmacology
BMCRI
DEFINITION
WHO defined as “Essential medicines are those that satisfy the priority health care needs of the majority of the population”
• Available at all times
• In adequate amounts
• Appropriate dosage forms
• At an affordable price
• Assured quality
THE CONCEPT OF ESSENTIAL MEDICINES
A limited range of carefully selected essential medicines leads to better health care, better drug management, and lower costs.
REASONS TO MAKE A LIST OF ESSENTIAL MEDICINES
1. Justice: Basic health services should be accessible to everyone in society
2. Supply and storage: Essential medicines list makes it easier to efficiently procure and supply a
limited number of medicines so that the public sector can afford it and quality can also be
controlled
3. Prescribing: List also facilitates rational prescribing by being more familiar with a smaller
number of medicines
4. Cost: Many drug suppliers will approach to supply this medicines, so with increased
competition more favourable prices can be negotiated.
5. Patient use: Patients will receive similar treatment from different providers (usually the
treatment of choice)
PROCESS OF DEVELOPING AN ESSENTIAL MEDICINE LIST
1. Disease prevalence survey: List common health problems from all available sources
2. Formulating standard treatment guidelines: Treatment guidelines are systematically
developed statements that assist prescribers in deciding appropriate treatments for specific
clinical problems
3. Matching of disease list and treatment options
4. Compiling the list of essential medicines: The type and amount of drugs supplied and stored
in a health facility shall be determined by the disease prevalence data and essential drug list of
that facility
CRITERIA FOR SELECTION OF ESSENTIAL MEDICINES
WHO list of essential medicines - Model or “guiding list”
1. Quality of drugs – Only those drugs should be selected for which sound & adequate data on
safety & efficacy are available.
2. Pattern of prevalent disease – Most effective drug against locally prevalent disease is selected.
3. Cost – Major consideration in drug selection. The cost of total treatment & not just one unit
must be considered.
4. Benefit risk ratio - When several comparable drugs are available for same therapeutic
indication, a drug which provides most favorable benefit / risk ratio is to be selected.
CRITERIA FOR SELECTION OF ESSENTIAL MEDICINES
5. Dosage forms
6. Financial resources
7. Genetic, Demographic & Environmental factors.
8. Mortality and morbidity statistics.
9. Local manufacture and storage facilities.
10. Essential medicines should be based on rationally developed treatment guidelines.
WHO MODEL LIST OF ESSENTIAL MEDICINES
• WHO list of essential medicines - Model or “guiding list”
• The first WHO model list was published in the year 1977 which had 186 medicines.
• WHO publishes Model list of essential medicine (EML) every two years, latest being the 22 nd
edition released in 2021.
• WHO also publishes list for children (EMLc), the 8th edition of the same was released in 2021.
NATIONAL LIST OF ESSENTIAL MEDICINES (NLEM)
• WHO EML is a model list, decision about which medicines are essential remains a national
responsibility based on the country’s disease burden, priority, health concerns, affordability etc.
• Government of India (GOI) released the first NLEM in 1996 containing 279 medicines
• National essential medicine list committee is constituted by the Ministry of Health and Family
Welfare
• Committee should consist of clinical pharmacologists, internists, infectious disease specialist,
surgeon, paediatrician, one or more district pharmacists, a hospital director and other specialists as
needed.
NLEM 2022
• Currently NLEM 2022 is being followed in India, which was an update from NLEM 2015
containing 376 medicines
• NLEM 2022contains 384 medicines (Added 34 medicines and deleted 26 medicines)
• NLEM can be a guiding document for
1. State governments to prepare their list of essential medicines
2. Procurement and supply of medicines in public sector
3. Reimbursement of cost of medicines by organisations to employees/insurance companies
ADVANTAGES OF ESSENTIAL MEDICINES LIST
1. More cost effective, management, purchase, storage and distribution.
2. Improved drug use in terms of safety, simplified and more efficient drug information
including training to health worker.
3. Identification & avoidance of adverse drug reaction and interaction.
4. Stimulation of local drug formulation and production.
DISADVANTAGES OF ESSENTIAL MEDICINES LIST
1. Reduced freedom of choice.
2. Creation of monopolies – Favoring a single drug product.
3. Reduced possibilities for gaining episodic experience e.g. new application of old drug.
4. Lack of interest for drug innovation.
ARE DRUGS ABSENT IN THE ESSENTIAL DRUGS LIST USELESS?
• List of essential drugs does not imply that no drugs outside it are useful.
• These drugs may be more expensive alternatives or useful only for uncommon ailments.
• May be harmful or hazardous.
• May be irrational fixed dose combination.
RELATED TERMINOLOGIES
• Core list – List of minimum medicine needs for a basic health care system, listing the most
efficacious, safe and cost effective medicines for priority conditions.
• Complementary list – Essential medicines for priority diseases , for which specialised
diagnostic or monitoring facilities and or specialist medical care and or specialist training are
needed.
Exercise 1
• Prepare a list of local anesthetics for
different healthcare facilities using page
4 of NLEM 2022
Exercise 2
• Prepare a list of medicines affecting
coagulation for different healthcare
facilities using pages 46 and 47 of NLEM
2022
TAKE HOME MESSAGE
• E – Efficacy
• S – Safety and suitability
• S - Storage and stability
• E - Ease of administration ( dosage form)
• N - Need of population
• T - Total cost
• I - Irrational combination to be avoided
• A- Availability, Affordability
• L - Listing regularly ( updating)
