The Model List of Essential Medicines of the World Health Organization (WHO) highlights medicines considered the most effective, safe, and important for priority public health needs.

In the years since its first publication in 1977, the Essential Medicines List has shaped the diffusion and reimbursement of new medicines in health systems around the world. The list, which remains a voluntary guideline for national formularies, was established with the goal of making included therapies widely available and affordable. However, the selection of medicines for inclusion in the list has been increasingly complicated by the escalating prices of new drugs entering the market. [JAMA Network}]

With the publication of its 2021 list, which comprised more than 400 medicines, WHO for the first time explicitly acknowledged that several medicines, including checkpoint inhibitors for lung cancers, were not on the list—despite being highly effective—due to prohibitively high prices.1 In this Viewpoint, we propose restructuring the list to formally remove consideration of cost and cost-effectiveness from the expert committee reviews of clinical effectiveness, safety, and public health value and chartering a new framework for pooled global negotiation and procurement of costly medicines eventually included in the list.

The recent update of the Essential Medicines List resurfaced a long-standing tension with some medications between high costs and essential need for health systems and patients. The roots of the current controversy can be traced to the introduction of the first antiretroviral therapies in the late 1990s that were costly; until then, cost (specifically, experts’ judgment about the affordability for low-income countries) had a central role in the consideration of whether a therapy should be included in the list. Full article here> 

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