Essential medicine lists are a tool for balancing public health needs with pharmaceutical market realities. Comment with reference to India and WHO frameworks.

Q. Essential medicine lists are a tool for balancing public health needs with pharmaceutical market realities. Comment. (15 marks, 250-350 words)

An essential medicines list identifies drugs that satisfy the priority healthcare needs of a population, selected on evidence of efficacy, safety and comparative cost-effectiveness. Such lists are genuinely a balancing instrument — they secure affordability without abolishing the market — but the balance holds only if revision keeps pace with therapeutic advance.

How the lists serve public health need - WHO's Model List, revised on a biennial cycle, is the global benchmark; its 24th edition (2025) carries over 520 medicines [4]. - The 25th Expert Committee (Geneva, May 2025) assessed 59 applications on efficacy, safety and cost-effectiveness, adding cancer therapies and GLP-1 agonists for type-2 diabetes with cardiovascular or renal comorbidity [3]. - India's NLEM 2022, framed by the Standing National Committee on Medicines (SNCM, constituted 2018) and notified on 13.09.2022, lists 384 medicines across 27 therapeutic categories, adding 34 and dropping 26 [1].

How they accommodate market realities - Listing is not nationalisation: it triggers ceiling prices fixed by the NPPA under the Drug Price Control Order, leaving manufacture, competition and non-listed drugs to the market. - Price re-fixation under NLEM 2022 yielded estimated annual savings of about ₹3,788 crore to patients — relief delivered through regulated pricing rather than subsidy [2]. - Selective coverage protects industry viability and R&D incentives while capping the drugs that matter most for out-of-pocket spending.

Where the balance slips - India's list is unrevised since 2022, while WHO has issued two updates (2023, 2025) [3][4]; newer essential therapies therefore stay outside price control. - Revision rests on administrative discretion, not a statutory timetable — civil society has urged early revision [5].

Essential medicine lists thus reconcile equity with market efficiency, but the reconciliation is dynamic, not one-time. Institutionalising a fixed two-year revision cycle for NLEM, with a standing SNCM secretariat and transparent stakeholder consultation, would align India with the WHO benchmark and advance both Article 21's promise of accessible healthcare and SDG-3's universal health coverage target.

(~320 words)

Sources: 1. Dr Mansukh Mandaviya launches National List of Essential Medicines (NLEM) 2022 — PIB — 384 medicines, 27 categories, 34 added/26 dropped, SNCM 2018, notification 13.09.2022 2. Average price reduction under NLEM 2022: estimated annual savings of ~₹3,788 crore — PIB — patient savings from ceiling-price fixation 3. WHO updates list of essential medicines to include key cancer, diabetes treatments (5 Sept 2025) — WHO — 25th Expert Committee, 59 applications, GLP-1 and cancer additions; 2023 and 2025 updates 4. WHO Model Lists of Essential Medicines — WHO — biennial revision cycle; 24th list (2025), over 520 medicines 5. "India's essential medicine list lags behind global benchmark; unrevised in 4 years" — The Hindu (news report) — civil society demand for early NLEM revision