National List of Essential Medicines: 34 drugs enlisted in update after 7 years

The latest National List of Essential Medicines features 384 medicines, drops 26 old ones

By Taran Deol
Published: Tuesday 13 September 2022

The latest National List of Essential Medicines (NLEM) released September 13, 2022 by the Union health ministry added 34 new medicines and dropped 26 old ones from the previous list.

A total of 384 medicines feature on NLEM 2022 under 27 therapeutic categories. 

This revised list has come out after a gap of seven years. Its primary aim is to promote rational use of medicines considering three important aspects — cost, safety and efficacy, the health ministry noted in a statement. 

“The concept is based on the premise that a limited list of carefully selected medicines will improve quality of healthcare, provide cost-effective healthcare and better management of medicines,” health minister Mansukh Mandaviya said while releasing the list. 

Drafting it was a lengthy process which included inputs from more than 350 experts from across the country with more than 140 consultation meetings. The list includes anti-infectives medicines to treat diabetes csuch as insulin — HIV, tuberculosis, cancer, contraceptives, hormonal medicines and anaesthetics.

Drugs listed under NLEM — also known as scheduled drugs — will be cheaper because the National Pharmaceutical Pricing Authority (NPPA) caps medicine prices and changes only based on wholesale price index-based inflation. 

They account for 17-18 per cent of the estimated Rs 1.6-trillion domestic pharmaceutical market. Companies selling non-scheduled drugs can hike prices by up to 10 per cent every year.

Typically, once NLEM is released, the department of pharmaceuticals under the ministry of chemicals and fertilisers adds them in the Drug Price Control Order, after which NPPA fixes the price. 

However, this year a standing committee was put in place to ensure some essential medicines are “adequately available at lower prices”, the Business Standard reported.

“NLEM plays an important role in ensuring accessibility of affordable quality medicines at all levels of healthcare. This will give a boost to cost-effective, quality medicines and contribute towards reduction in Out of Pocket Expenditure on healthcare for the citizens,” the health minister said. 

This is critical because the recently released National Health Accounts Estimates 2018-19 points to a high burden on households to pay for healthcare, which is a key reason pushing Indians into poverty. 

In Uttar Pradesh for example, out-of-pocket health expenditure accounts for 71.3 per cent of the state’s total health expenditure. For India, the figure was 48.2 per cent.

Several factors influence the decision to include a drug in the NLEM. Exactly how essential the medicine is is key. But that is not all. As per the 2015 regulations, “every medicine may be necessary or even critical for specific disease conditions for which it is indicated. But in the context of NLEM, a medicine may be essential considering the population at large and should fit into the definition mentioned earlier.” 

A changing disease burden also impacted the decision-making process. Other factors include efficacy, safety and cost-effectiveness. 

A drug is removed from NLEM if another medicine performs better in terms of these above-mentioned factors. 

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