• Experts committee driven by consensus-building to decide: NMRA 
• Meds imports based on priority list by Health Ministry: SPC
• Revision of essential meds list will not impact prices: AIPPOA

Sri Lanka’s healthcare landscape is facing significant scrutiny as the nation’s essential medicines list undergoes revision by a committee appointed by the National Medicines Regulatory Authority (NMRA). 

NMRA Chairman Dr. Ananda Wijewickrama emphasised on the collaborative nature of this process, guided by a committee of experts and driven by consensus-building.

“I can’t say precisely what will be added and what will be removed because those will come after a lot of discussions,” Dr. Wijewickrama told The Sunday Morning. “Periodically, we include new medicines and sometimes we have to remove certain medicines which are not currently being used.”

The essence of the essential medicines list lies in its assurance of constant availability of crucial medications nationwide, whether imported or locally produced. “Having an essential medicines list means that those medicines should be made available constantly in the country,” Dr. Wijewickrama emphasised.

This process is integral to addressing evolving healthcare needs and therapeutic advancements, ensuring that the list remains aligned with the population’s health priorities.  

Essential medicines list background 

In 1958, Sri Lanka took pioneering steps by establishing medicines lists for both the State and private healthcare sectors. Notably, Professor Senaka Bibile played a pivotal role by publishing the ‘Ceylon Hospitals Formulary,’ providing comprehensive guidance on the usage of these medications. 

Furthermore, Prof. Bibile’s initiatives included the establishment of an international procurement system, leading to cost reductions and enhanced availability of essential medicines, thereby advancing healthcare accessibility and affordability.

According to the World Health Organization (WHO), essential medicines are meticulously chosen, taking into account clinical requirements, disease prevalence, and evidence regarding efficacy, safety, and comparative cost-effectiveness. The overarching objective is to ensure their consistent availability in functioning healthcare systems, offering adequate quantities, appropriate dosage forms, guaranteed quality, and affordability for individuals and nations alike.

The core list delineates the minimum medication necessities for a rudimentary healthcare system, featuring the most effective, safe, and cost-efficient medications for priority conditions. These priority conditions are identified based on their current and projected public health significance, as well as the potential for safe and cost-effective treatment.

Additionally, the complementary list comprises essential medicines tailored to priority diseases necessitating specialised diagnostic or monitoring facilities, specialist medical care, or specialised training. 

In cases of uncertainty, medicines may also be included as complementary based on consistently higher costs or less favourable cost-effectiveness across various settings. Moreover, the listed medicine should serve as the exemplar for its class, supported by the strongest evidence of effectiveness and safety.

The WHO Model Lists of Essential Medicines and Model List of Essential Medicines for Children serve as dynamic guides, updated and published biennially, to aid countries or regional authorities in shaping their own essential medicines lists in alignment with local priorities and treatment guidelines. 

This selective approach to essential medicines, tailored to national disease burdens and clinical needs, can yield manifold benefits. By streamlining procurement and distribution processes for quality-assured medicines, it facilitates enhanced access to essential treatments. Furthermore, it promotes rational prescribing practices and fosters cost savings for both healthcare systems and patients alike.

Medicine categories 

In the Medical Supplies Division’s (MSD) approved list of pharmaceutical items (Formulary Revision 2016/2017), medicines are categorised into three main groups: Vital (V), Essential (E), and Non-essential (N). 

Vital medicines are deemed essential for saving lives and providing fundamental healthcare services, necessitating their constant availability for prompt treatment of critical conditions. 

Essential medicines, while not as critical as vital ones, are crucial for meeting the healthcare needs of the majority of the population and maintaining public health. They should be easily accessible in appropriate quantities, forms, and prices. 

Non-essential medicines, on the other hand, are primarily used for minor ailments, have questionable effectiveness, or are relatively expensive with minimal therapeutic benefits. 

Alongside these categories, medicines are also sorted based on their supply and usage: Regular Items, which are routinely supplied by pharmaceutical companies and approved for general medical practice; Complementary Items, comprising essential medicines for priority diseases requiring specialised care or based on cost considerations; and Named Patient Items, prescribed for specific patients and conditions, often reflecting individualised treatment needs or rare diseases. 

This systematic categorisation aims to ensure efficient allocation of resources, equitable access to essential treatments, and optimisation of healthcare delivery.

Prices will not change 

Speaking to The Sunday Morning, State Pharmaceuticals Corporation (SPC) General Manager Dinusha Dasanayake said the imports of medicines were based on the priority list prepared by the Health Ministry.

According to Dasanayake, the priority list comprises around 800 medicines and includes all essential medicines, amounting to around 400.

Meanwhile, All-Island Private Pharmacy Owners’ Association (AIPPOA) President Chandika Gankanda said that the amendment of the essential medicines list would not affect the medicine prices unless the medicines were included into the Maximum Retail Price (MRP) list. “The prices will not be changed by amending the essential medicines list,” he said.

As learnt by The Sunday Morning, Sri Lanka controls the MRP of 60 medicines.