|Managing Medicine Selection. (MDS-3: Managing Access to Medicines and Health Technologies, Chapter 16)
(2012; 16 pages)
The rationale for selecting a limited number of essential
medicines is that it may lead to better supply, more
rational use, and lower costs. Essential medicines are
those that are deemed to satisfy the health care needs of
the majority of the population and that should be available
in the appropriate dosage forms and strengths at
all times. Because selection of medicines has a considerable
impact on quality of care and cost of treatment,
it is one of the most cost-effective areas for intervention.
A list of essential medicines may be selected for use in
one or more health facilities or for the public sector as
a whole. In the latter case, the list usually indicates the
level of the health care system where each medicine
may be used. It can also be considered a supply list.
A formulary system is part of the medicine selection
process. The system includes a formulary list, which
is ideally based on an essential medicines list, and a
formulary manual, which contains summary information
on each medication on the formulary list. Standard
treatment guidelines are systematically developed statements
that assist prescribers in deciding on appropriate
treatments for specific clinical problems. Whereas
a formulary manual is medicine centered, treatment
guidelines are disease centered, presenting treatment
alternatives and recommending a treatment of first
The process of selecting essential medicines begins with
defining a list of common diseases for each level of health
care. The treatment of first choice for each health problem
is the basis for the list of essential medicines, the
national formulary system, and the treatment guidelines.
The supply system should then supply the medicines that
have been selected, based on this series of steps.
Essential medicines should be selected on the basis of
(1) relevance to the pattern of prevalent diseases, (2)
proven efficacy and safety, (3) adequate scientific data
and evidence of performance in a variety of settings,
(4) adequate quality, (5) favorable cost-benefit ratio,
(6) desirable pharmacokinetic properties, (7) possibilities
for local manufacture, and (8) availability as single
compounds. The drugs should be identified by the
International Nonproprietary Name (INN), sometimes
referred to as the generic name.
General acceptance of an essential medicines list can be
promoted by wide consultation with senior specialists
and experts, including professional organizations and
academic institutions, on the list’s development and use.
An open and transparent system of regular updates is an
absolute prerequisite for maintaining the authority and
acceptance of an essential medicines list or formulary list.
The essential medicines concept can be applied in any
country, in the public and private sectors, and in rural
areas as well as at referral hospitals.