In a significant development, a coalition of health experts and patient advocacy groups in India has called for the urgent revision of the National List of Essential Medicines (NLEM) to include several critical cancer therapies. The current NLEM, notified in 2022, has not been updated to reflect the latest World Health Organization (WHO) Model List of Essential Medicines, which underwent revisions in 2023 and 2025. This delay has resulted in the omission of several life-saving cancer drugs from the list, thereby restricting their affordability and accessibility to patients across the country.
The Working Group on Access to Medicines and Treatments, a coalition comprising public health experts, civil society organizations, patient groups, researchers, and advocates, has highlighted the absence of 17 active cancer medicines, four supportive cancer drugs, and nine monoclonal antibodies (mAbs) from the NLEM. Among the notable omissions are pembrolizumab (sold under the brand name Keytruda) and ibrutinib, both of which have revolutionized cancer treatment globally. Pembrolizumab is a monoclonal antibody that has transformed care in 22 different types of malignancies, while ibrutinib has been pivotal in treating certain aggressive forms of blood cancers.
The absence of these drugs from the NLEM has significant implications for patients in India. Without inclusion in the NLEM, these medications are not subject to price controls imposed by the National Pharmaceuticals Pricing Authority (NPPA), making them prohibitively expensive for many patients. The NLEM serves as a guide for the government to regulate the prices of essential medicines, ensuring they remain affordable and accessible to the general population.
The coalition has urged the Union Health Ministry to expedite the revision of the NLEM to align it with the latest WHO recommendations. They emphasize that timely inclusion of these critical medicines will not only make them more affordable but also uphold India's commitment to universal health coverage and the right to health. The delay in updating the NLEM is viewed as a potential violation of the constitutional right to life and health, as affirmed by the Supreme Court in several landmark judgments.
The call for revision is also supported by the Tata Memorial Centre, India's premier oncology treatment institute. In 2014, the center recommended the inclusion of 12 key cancer drugs in the NLEM, highlighting the importance of these medicines in cancer treatment and the potential for significant price reductions if they were brought under government regulation.
The inclusion of these drugs in the NLEM is not only a matter of affordability but also of equity. Patients in India should have access to the same standard of care as those in other parts of the world. The omission of these essential medicines from the NLEM perpetuates disparities in healthcare access and outcomes. By revising the NLEM to include these drugs, the government can take a significant step towards ensuring equitable healthcare for all citizens.
In conclusion, the urgent revision of the NLEM to include critical cancer therapies is imperative. It is a matter of public health, human rights, and social justice. The government must act swiftly to update the list, ensuring that all patients have access to the best possible treatments available.
The Working Group on Access to Medicines and Treatments continues to advocate for this revision, emphasizing the need for a transparent, time-bound, and conflict-of-interest-free process to update the NLEM. They call on all stakeholders, including healthcare professionals, policymakers, and the public, to support this crucial initiative to improve cancer care in India.
As the global community continues to make strides in cancer research and treatment, it is essential that India keeps pace with these advancements. Incorporating the latest evidence-based therapies into the NLEM is a vital step towards achieving this goal and ensuring that all patients have access to the best possible care.
The coalition remains hopeful that the government will recognize the urgency of this matter and take prompt action to revise the NLEM, thereby fulfilling its constitutional obligations and international commitments to health equity.
In the meantime, patients and healthcare providers continue to face challenges in accessing these essential cancer therapies. The Working Group on Access to Medicines and Treatments urges the government to prioritize this issue and work collaboratively with all stakeholders to find solutions that will benefit patients across the country.
The inclusion of these critical cancer drugs in the NLEM is not just a policy change; it is a commitment to the health and well-being of millions of Indians. It is a recognition that access to essential medicines is a fundamental human right and a cornerstone of a just and equitable society.