The Union Health Ministry recently published the new National List of Essential Medicine (NLEM)-2022, which is revised every seven years.
The new list includes more cancer medications, newer diabetes medications, and even four patent-protected drugs.
What is National List of Essential Medicines?
The list, curated by experts in consultation with stakeholders, includes medicines that are required to address the majority of the population’s priority healthcare needs. The drugs included are those that are both effective for treating a specific condition and cost-effective. This is why generics are almost always included on the list (unbranded medicines, like paracetamol instead of crocin).
The list usually includes medicines that are a part of government’s health programmes, such as bedaquiline, included in the 2022, that is used in the country’s TB elimination programme.
The list establishes a framework for medicine procurement at government healthcare facilities; essential medicines should ideally be available at all healthcare facilities, depending on the level of care (NLEM marks all drugs as P, S, or T depending on whether they ought to be available at primary, secondary or tertiary healthcare facilities). It also assists hospitals in developing drug policies, such as which medicines to use – the NLEM-2022 switched up several antibiotics based on resistance patterns, including a strong, broad-spectrum antibiotic Meropenem on the list.
It assists government facilities that provide free medicines in determining which ones to prioritise, and it can also be used by agencies that reimburse the cost. Furthermore, the list aids in the education of young doctors on the proper use of medications.
The list’s most important application, however, is to make these medications more affordable to the general public.
Drugs added to the NLEM-2022
The new list includes 34 medicines that were not previously included in the NLEM-2015, most notably four cancer medicines: Bendamustine Hydrochloride, which is used to treat certain types of blood and lymph node cancers, Irinotecan HCI Trihydrate, which is used to treat colorectal and pancreatic cancers, Lenalidomide, which is used to treat various types of cancers, and Leuprolide acetate, which is used to treat prostate cancer. Cancer therapies are typically very expensive, but they also have higher profit margins.
The list also includes two newer classes of drugs that are now routinely used by doctors for diabetes management: the medicine Teneligliptin and the insulin Glargine. The rotavirus vaccine, which is now included in the government’s universal immunisation programme, is also included.
Importantly, the list includes at least four drugs that are still under patent, including Bedaquiline and Delaminid for tuberculosis, Dolutegravir for HIV, and Daclatasvir for Hepatitis C treatment, all of which are part of the government’s national health programmes. This is the first time patented drugs have been included in the list, as these drugs are typically more expensive.
The list has made another notable addition – it has included nicotine and opioid replacement therapy, with no therapy in the category available in the previous lists.
Drugs removed from the NLEM-2022
The previous list was reduced by 26 drugs, bringing the total number of drugs in the NLEM-2022 to 384. Three anti-tuberculosis drugs were deleted, including Kanamycin injection, which was used in patients with drug-resistant TB. Aside from the fact that the government is now implementing an all-oral regimen for such patients, the drug was also linked to serious side effects such as kidney problems and hearing loss.
While adding antibiotics like meropenem and anti-parasitic ivermectin (which is also a part of the government’s lymphatic filariasis programme), the list has deleted antimicrobials like capreomycin, ganciclovir (that is known to be a carcinogen and lead to embryo malformation), and a hepatitis medicine with poor efficacy. Petroleum jelly and bleaching powder have also been removed from the list.