The WHO Model List of Essential Medicines has served as a template for national formularies since its first publication in 1977. It affects the diffusion and reimbursement of new medicines in many health systems around the world. In a Viewpoint article, authors examine the impact of escalating drug prices on inclusion decisions for the list, which has begun leaving effective drugs off because of their high prices. The authors discuss WHO’s decisions for the PD/PD-L1 inhibitors (noninclusion), pertuzumab (noninclusion), and SGLT-2 inhibitors (inclusion).
“The public health challenge of unaffordable medicines is likely to grow in the coming years, further straining the process of updating WHO’s Essential Medicines List,” the authors write. “The innovation landscape is markedly different from when the Essential Medicines List was first published in 1977 or even when the rules of procedure were last updated in 2001. The emergence of more effective and highly costly therapies, including gene and cell therapies, will further highlight the need for a new approach to determining which medicines are deemed essential. By separating clinical reviews from cost considerations and by working to strengthen pooled drug price negotiation and procurement, WHO could strengthen trust in the Essential Medicines List and establish a more durable foundation for global access to essential medicines.”