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.

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 …