For a ‘Swasth Bharat’ accessibility and affordability of medicines at affordable price are very critical component of an effective universal healthcare services. After four years, the NLEM is being revised and the process of consultations is now over. Compilation work would be over soon and following this the government would announce the new list.
“Compilation of the list is on and very soon, the Ministry of Health would announce the revised and new NLEM 2015,” said a senior health ministry official.
Delays is because of the complexity of the issue and each inclusion and deletion in the list require due consideration from our side as well,” he added.
To revise NLEM 2011, a Core Committee, headed by VM Katoch, secretary, department of health research, was formed in May 2014. Prof YK Gupta, Head of Pharmacology Department, AIIMS is the Vice-Chairman of the Committee.
In March this year the Committee completed five rounds of consultations with expert groups in five metros. It is reliably learnt that during the meetings, experts suggested that there is a need of India-centric list as prevalence of diseases is not similar in the USA or Europe.
The Core Committee is understood to have taken all aspects under consideration to identify more drugs for the NLEM. It has also ensured that all life-saving and essential drugs of mass consumption are included in the revised NLEM for safeguarding public interest.
Safety, efficacy and cost-effectiveness are key concerns of NLEM. The first NLEM was prepared and released in 1996. It was subsequently revised in 2003. The NLEM 2011 has 348 medicines from 27 therapeutic categories such as cardiovascular, anti-cancer, antineoplastic, immunological, anti-infective, ophthalmological preparations, diuretics, anti-allergic, etc. Medicines have also been categorised on the basis of essentiality at different levels of healthcare.
There are 181 medicines for primary (P), secondary (S) and tertiary (T) healthcare. 106 are for secondary(S) and tertiary (T) healthcare, while 61 are for tertiary (T) healthcare only.
According to sources, the number of medicines would go up in the new list and it would be India-centric which means medicine appropriate for wide prevalence of diseases in the country would be given priority.
Big question here is, whether every medicine or the largest selling drugs can or should be categorised as essential. Market manipulation is not unknown. It is widely agreed that price mechanism is often controlled by market forces and some essential drugs mentioned in the NLEM disappear from the market. Experts recommend that to avoid such situations, we need to inculcate rational prescription practice among doctors.
According to Indian Pharma Industry, the new NLEM should also ensure that it does not kill innovation and manufacturing in India.
India imports cheaper drugs from China if they are found expensive to manufacture in the country. According to a Parliamentary Standing Committee report on Department of Pharmaceuticals, Rs 17,944 crore was spent in 2013-14 to import medicinal and pharmaceutical products.
Expressing concern over large sum of money spent on importing pharmaceutical products, Parliamentary Panel also called for incentivising domestic bulk drug industry and discourage Indian firms from buying from overseas.
Moreover, the Committee said that all medicines are essential and recommends expanding the scope of price control to cover all medicines available in the country.
However, Prof YK Gupta, Vice Chairman of the Committee said, “The Core Committee of Experts, with wider consultations with all stakeholders, has tried to come out with the ‘best fit list’ and the new list should not be perceived only as a tool of price control.”