A civil society collective, the Working Group on Access to Medicines and Treatments, has written to the Government of India demanding urgent revision of the National List of Essential Medicines (NLEM), pointing out that India’s list has remained unrevised for nearly four years even as the World Health Organization has updated its own Model List twice during the same period. This gap between India’s essential medicines framework and global best practice raises serious concerns about healthcare access, affordability, and the constitutional right to health for India’s population, making it a critical topic for UPSC and SSC aspirants studying health policy and social justice.
The NLEM is not a mere administrative catalogue; it is the backbone of India’s public health pricing and procurement architecture, directly determining which medicines are available free of cost at government hospitals and which drugs fall under price ceiling regulation enforced by the National Pharmaceutical Pricing Authority. When the list fails to keep pace with medical advances, patients suffering from cancer, diabetes, and other chronic conditions are deprived of access to critical therapies at affordable prices, effectively widening health inequities.
ЁЯТб Get AI-powered exam prep on your phone!
This issue also intersects with India’s broader Ayushman Bharat and universal health coverage aspirations, since the effectiveness of any health insurance or public health delivery scheme is fundamentally constrained by whether the underlying essential medicines framework reflects current therapeutic standards.
Background and Context
The NLEM was first introduced in 1996 and has been periodically revised, with the most recent overhaul occurring in 2022, expanding the list to 384 medicines. The WHO Model List of Essential Medicines, by contrast, has been revised in both 2023 and 2025 and currently contains 523 medicines, reflecting evolving global therapeutic standards and pharmaceutical innovation.
Five Important Key Points
- India’s National List of Essential Medicines contains 384 medicines and was last revised in 2022, while the WHO Model List, revised twice since then, now contains 523 medicines, leaving India’s list significantly behind global benchmarks.
- The Working Group on Access to Medicines and Treatments identified 17 active cancer-treating agents and four supportive cancer-care medicines featured on the WHO list but absent from India’s NLEM.
- Nine monoclonal antibodies, a class of targeted biologic drugs increasingly central to modern cancer treatment, do not currently appear on India’s essential medicines list despite their inclusion in global therapeutic guidelines.
- The NLEM directly determines free dispensation of medicines at government hospitals and instructs the National Pharmaceutical Pricing Authority to enforce strict price ceilings, making its composition critical to both access and affordability.
- The collective, comprising patient advocates, civil society organisations, academics, lawyers, and journalists, has urged a transparent, time-bound, and conflict-of-interest-free revision process aligned with the WHO Model List and India’s public health priorities.
Legal and Institutional Framework
The NLEM operates under the broader framework of the Drugs (Prices Control) Order, 2013, issued under the Essential Commodities Act, 1955, which empowers the National Pharmaceutical Pricing Authority to fix ceiling prices for scheduled formulations listed in the NLEM. This linkage means that any delay in revising the NLEM has cascading effects on drug pricing policy, since medicines outside the list remain largely unregulated in terms of pricing, potentially exposing patients to significant out-of-pocket expenditure.
Right to Health and Constitutional Dimensions
While the Indian Constitution does not explicitly enumerate a fundamental right to health, the Supreme Court has consistently read this right into Article 21’s guarantee of the right to life, most notably in cases establishing that access to healthcare, including affordable medicines, constitutes an essential component of a dignified life. The Working Group’s letter explicitly frames NLEM revision as essential to safeguarding this constitutional guarantee, positioning the issue within a rights-based rather than purely administrative framework.
Economic Implications for Healthcare Financing
Out-of-pocket health expenditure remains disproportionately high in India compared to countries with more comprehensive essential medicines frameworks, and this burden falls hardest on families dealing with catastrophic illnesses like cancer, where treatment costs can rapidly deplete household savings. Timely NLEM revision incorporating new cancer therapeutics and monoclonal antibodies could substantially reduce this financial burden by bringing these drugs under price ceiling regulation and free public dispensation, thereby advancing both health and economic security objectives simultaneously.
Governance Concerns and Institutional Inertia
The nearly four-year delay in NLEM revision raises questions about institutional capacity and political prioritisation within the Ministry of Health and Family Welfare. Given that the NLEM revision process requires extensive technical consultation involving pharmacological experts, cost-effectiveness analysis, and stakeholder engagement, delays may partly reflect genuine procedural complexity; however, the Working Group’s demand for a “conflict-of-interest-free” process implicitly suggests concerns about pharmaceutical industry influence potentially slowing down inclusion of certain drug categories.
Bihar’s Stake in Essential Medicine Access
Bihar’s healthcare indicators, including high out-of-pocket health expenditure and limited access to advanced cancer and chronic disease treatment infrastructure, make the state particularly vulnerable to gaps in the essential medicines framework. Bihar’s public hospitals, which serve a population with comparatively lower per capita income and higher poverty incidence than the national average, rely heavily on the NLEM’s free dispensation provisions; any expansion of the list to include modern cancer therapeutics and monoclonal antibodies would disproportionately benefit Bihar’s population, who otherwise face significant barriers to accessing costly biologic treatments available primarily in metropolitan private hospitals.
Way Forward
The Ministry of Health and Family Welfare should institute a fixed biennial revision cycle for the NLEM, mirroring the WHO’s own revision frequency, to prevent future multi-year gaps. Establishing a transparent, publicly disclosed conflict-of-interest declaration process for all experts involved in NLEM revision committees would enhance institutional credibility. Fast-tracking inclusion of high-burden disease categories, particularly oncology and monoclonal antibody therapies, through an expedited technical review pathway would address the most urgent access gaps identified by civil society.
Relevance for UPSC and SSC Examinations
This topic is highly relevant to GS Paper II, covering health policy, government schemes for vulnerable sections, and issues relating to poverty and hunger. It also connects to GS Paper III on science and technology as applied to pharmaceutical innovation. Key terms include: National List of Essential Medicines (NLEM), WHO Model List of Essential Medicines, National Pharmaceutical Pricing Authority, Drugs (Prices Control) Order 2013, Essential Commodities Act 1955, and Article 21.