Objective To compare the medicines included in national essential medicines lists with the World Health Organization’s (WHO’s) Model list of essential medicines , and assess the extent to which countries’ characteristics, such as WHO region, size and health care expenditure, account for the differences. Methods We searched the WHO’s Essential Medicines and Health Products Information Portal for national essential medicines lists. We compared each national list of essential medicines with both the 2017 WHO model list and other national lists. We used linear regression to determine whether differences were dependent on WHO Region, population size, life expectancy, infant mortality, gross domestic product and health-care expenditure. Findings We identified 137 national lists of essential medicines that collectively included 2068 unique medicines. Each national list contained between 44 and 983 medicines (median 310: interquartile range, IQR: 269 to 422). The number of differences between each country’s essential medicines list and WHO’s model list ranged from 93 to 815 (median: 296; IQR: 265 to 381). Linear regression showed that only WHO region and health-care expenditure were significantly associated with the number of differences (adjusted R 2 : 0.33; P < 0.05). Most medicines (1248; 60%) were listed by no more than 10% (14) of countries. Conclusion The substantial differences between national lists of essential medicines are only partly explained by differences in country characteristics and thus may not be related to different priority needs. This information helps to identify opportunities to improve essential medicines lists.

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Objectives. To compare national essential medicines lists (NEMLs) from countries in the Region of the Americas and to identify potential opportunities for improving those lists. Methods. In June of 2017, NEMLs from 31 countries in the Americas were abstracted from documents included in a World Health Organization (WHO) repository. The lists from the Americas were compared to each other and to NEMLs from outside of the Americas, as well as with the WHO Model List of Essential Medicines, 20th edition (“WHO Model List”) and the list of the Pan American Health Organization (PAHO) Regional Revolving Fund for Strategic Public Health Supplies (“Strategic Fund”). Results. The number of differences between the NEMLs from the Americas and the WHO Model List were similar within those countries (median: 295; interquartile range (IQR): 265 to 347). The NEMLs from the Americas were generally similar to each other. While the NEMLs from the Americas coincided well with the Strategic Fund list, some medicines were not included on any of those NEMLs. All the NEMLs in the Americas included some medicines that were withdrawn due to adverse effects by a national regulatory body (median: 8 withdrawn medicines per NEML; IQR: 4 to 12). Conclusions. The NEMLs in the Americas were fairly similar to each other and to the WHO Model List and the Strategic Fund list. However, some areas of treatment and some specific medicines were identified that the countries should reassess when revising their NEMLs.

ObjectivesThe experiences of people who report cost-related medicine non-adherence are not well documented. We aimed to present experiences relating to accessing medicines reported by the participants in a randomised controlled trial of free medicine distribution.MethodsThe trial consisted of primary care patients from a large urban family practice and three rural family practices who reported cost-related medicine non-adherence. Participants were randomly allocated to continue their poor access (control) or to receive free and easily accessible medicines (intervention). As part of data collection for the first year of the trial, participants were asked closed and open-ended questions to assess their adherence to medication, health outcomes and their experiences in relation to medicine accessibility. We conducted a qualitative concept mapping study in which we analysed and summarised participants’ responses to the open-ended question on a concept map to visually present their experiences relating to accessing medicines.ResultsOf the 524 trial participants contacted, 198 (38%) responded to the open-ended question. The concept map contains clusters that represent eight types of experiences of participants related to medicine access including stress, relationship with doctor, health impact, quality of life, sacrificing other essentials, medicines are expensive, financial impact and adherence. These experiences fall under two major themes, experiences relating to personal finances and experiences relating to well-being, which are bridged by a central cluster of adherence.ConclusionsThe experiences shared by the participants demonstrate that access to medicines impacts people’s finances and well-being as well as their adherence to prescribed medicines. These results indicate that effects on personal finances and general well-being should be measured for interventions and policy changes aimed at improving medicine access.Trial registration numberThis article is linked to the Carefully Selected and Easily Accessible at No Charge Medicines (CLEAN Meds) randomised controlled trial (trial registration number: NCT02744963).

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Background National essential medicines lists are used to guide medicine reimbursement and public sector medicine procurement for many countries therefore medicine listings may impact health outcomes. Methods Countries’ national essential medicines lists were scored on whether they listed proven medicines for ischemic heart disease, cerebrovascular disease and hypertensive heart disease. In this cross sectional study linear regression was used to measure the association between countries’ medicine coverage scores and healthcare access and quality scores. Results There was an association between healthcare access and quality scores and health expenditure for ischemic heart disease (p ≤ 0.001), cerebrovascular disease (p ≤ 0.001) and hypertensive heart disease (p ≤ 0.001). However, there was no association between medicine coverage scores and healthcare access and quality scores for ischemic heart disease (p = 0.252), cerebrovascular disease (p = 0.194) and hypertensive heart disease (p = 0.209) when country characteristics were accounted for. Conclusions Listing more medicines on national essential medicines lists may only be one factor in reducing mortality from cardiovascular disease and improving healthcare access and quality scores.

Aim: Diabetes is the ninth leading cause of death. Improving access to diabetes medicines may decrease mortality. Diabetes medicines on national essential medicines lists (NEMLs) vary considerably. We examine the association between diabetes population health outcomes relating to mortality and the listing of diabetes medicines on national essential medicine lists for 127 countries.Materials and methods: We conducted a cross-sectional study. We determined the number of diabetes medicines on NEMLs and used multiple linear regression to analyse the association between diabetes health outcomes and the number of medicines on NEMLs. We used linear regression to assess the association between diabetes health outcomes and the listing of or not listing of medicines that were listed by 25-75% of countries. Diabetes prevalence, gross domestic product (GDP) per capita and mean expenditure per person with diabetes were controlled for in all analyses.Results: The total number of diabetes medicines listed on NEMLs ranged from 0 to 16 (median: 4; interquartile range: 3-6). Diabetes health outcome scores were associated with the number of diabetes medicines on NEMLs [1.3-point increase (95% confidence interval, 95% CI 0.5-2.1) for every additional medicine on NEMLs; P = .002] and GDP per capita [19.5-point increase (95% CI 5.4-33.6) for every 10-fold increase in GDP; P = .003]. Diabetes expenditure was not associated with health outcome scores (P = .23). Increases in diabetes health outcomes score were associated with the listing of glimepiride (7.9-point increase, 95% CI 2.3-13.5, P = .006) and glipizide (5.8-point increase, 95% CI 0.03-11.6, P = .049) on NEMLs.Conclusions: Listing of diabetes medicines on NEMLs has the potential to improve population health outcomes related to mortality in countries with diverse incomes and diabetes prevalence without necessarily increasing diabetes health expenditure.diabetes, essential medicines, health equity, health outcomes, mortality 1 | INTRODUCTION Diabetes is the ninth major cause of death globally 1 and many patients with diabetes are still inadequately treated, particularly in low-and middle-income countries (LMICs). 2 The World Health Organization (WHO) has set a voluntary target of 80% availability and 50% use of affordable essential medicines to treat non-communicable diseases in the public and private sectors by 2025. 3 However, this target is only consistently met in high-income countries. 2 The International Diabetes Federation (IDF) conducted a global survey, in 2016,

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