List of Essential Medicines

To combat the shortage of prescription drugs, experts say Canadian authorities should declare a list of essential medicines.

The web site currently lists more than 800 medicines either unavailable or in short supply, causing inconvenience to doctors and possible harm to patients. More than one hundred countries have fought back by creating a list of essential medicines. An article just published in the Canadian Medical Association Journal says Canada should do the same.  The article is behind a paywall. Let's see if we can get it lifted! 

An essential medicines list is a set of drugs that the government deems as too important to be permitted to run out. The list could include prescription drugs, over the counter preparations and natural health products that the government commits to keep in stock.  A panel of experts would select medicines that make the cut based on effectiveness, safety and cost.  The list could also be used an educational tool to remind doctors in an unbiased way which treatments are the most appropriate; it could also be used to help manage the runaway cost of prescription drugs.  The list would not be exhaustive.  In Canada, there are more than 8000 pharmaceutical drugs for sale. Experts say the essential list would contain anywhere between 200 and 500 medicines at any one time.

Not every drug is in short supply, but some categories of medications have acute shortages. The Canadian Epilepsy Alliance tracks shortages of epilepsy drugs. It says nearly three out of every four medications used to control epileptic seizures have been affected by shortages, up from two out of every three drugs a year ago.  Shortages of antibiotics have been cited as a factor in an increase in cases of syphilis in Manitoba.  In March of this year, there were shortages of drugs used to treat asthma.  In Halifax earlier this year, there was a reported shortage of Epi-Pens, which are used by kids and adults to treat life-threatening allergies to peanuts and other substances.  We've seen shortages of cancer chemotherapy drugs as well as medications used to treat tuberculosis.

The authors of the article in CMAJ say studies show that an essential medicines list is associated with increased availability of drugs. It is also associated with better prescribing by doctors and more appropriate use by patients. This is especially true of low and middle-income nations.  For instance, after creating a list of essential medicines back in 2000, India was able to provide these drugs to up to 95% of patients and save an estimated 30 per cent annually on drug costs.  Among developed nations, Norway has had very few shortages since establishing a list of essential medicines. 

I visited Sweden last fall.  You can catch that episode here. That country has what it calls a wise list of 200 drugs - a smart evidence based list of medicines they deem both essential and cost effective.

Critics say that countries that have created essential medicines lists continue to experience drug shortages.  Such lists need to be updated and checked for errors.  The authors of the article in CMAJ acknowledge that a list of essential medicines cannot be the sole protection against global drug shortages  which since 2010 have been occurring with increasingly frequency. There are worldwide shortages of some raw ingredients used to make pharmaceutical drugs.  Drugs that are off patent are in particularly short supply.  If prices demanded by hospitals and insurance drug plans fall below production and distribution costs, manufacturers simply stop making them.  Shortages can lead to hoarding, gray marketing of drugs, and buying up temporary supplies at huge mark up. 

The federal government intends to make reporting of drug shortages mandatory.  Until recently, such reporting has been voluntary.  The people who watch the problem say that's a welcome development.  Some say an essential medicines list could be the first step along the road to a national pharmacare program  by proffering a list of drugs that would be publicly funded for all Canadians.  The authors of the study hope that Canada takes the example of other countries such as Sweden and develop a wise list of drugs based on scientific evidence.  Once the list is created, they say the federal government might negotiate with drug companies to secure supplies at reasonable prices. 

The authors say Canada has greater purchasing power than other nations that have essential medicines lists and should follow their example.

In other words, Canada could and should be doing a lot more to guarantee a supply of essential drugs.


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