Several expensive new drugs that treat hepatitis C and some common cancers appear on the latest Essential Medicines List (EML) published by the World Health Organization (WHO). An expert committee every 2 years selects medicines for the list based on scientific evidence that the drugs work and are safe and cost effective. This year’s list, released 8 May, includes five new drugs that target the hepatitis C virus (HCV) and 16 new cancer medicines. Notably pricey members of the influential list include sofosbuvir for HCV and the antileukemia drug Gleevec. (In wealthy countries, a full course of treatment with these drugs costs more than $75,000 per patient.) “We are trying to use the list as leverage for increasing access and further actions on a global level,” says Nicola Magrini, a pharmacologist in Bologna, Italy, and WHO’s top overseer of EML.
Many developing countries use EML to arrive at their own lists, which help determine how much money they invest in different medicines. “Calling some drugs ‘essential’ makes it clear that they are more important than others, and countries drive their attention to these medicines,” Magrini says. But he stresses that WHO “assists” countries but does not “steer” them, and it also “is not involved in price setting or price negotiation.”
EML includes more than 400 drugs and vaccines and focuses on common diseases and conditions. Magrini describes the list as “a flag” from a neutral party that a “cost-effective” drug is of little use if countries cannot afford it. “This speaks to a need to redefine what cost effectiveness means,” Magrini says. “It’s not a part of the solution. It’s part of the problem.”
But Magrini says it still takes too long for many lifesaving medicines to become widely available and that EML highlights the gaps. For example, sofosbuvir’s manufacturer, Gilead Sciences Inc. of Foster City, California, sells the drug to Egypt at a discount and allows generic manufacturers in India to produce and sell in 91 poorer countries. But advocates have criticized Gilead for not offering deals to some 50 middle-income countries, and they hope the EML listing—which the company actually requested—will build momentum to lower pricing worldwide. “The list is a very clever tool,” Magrini says.