Abstract
ObjectiveTo explore the perspectives of a diverse group of stakeholders engaged in medicines decision making around what constitutes an “essential” medicine, and how the Essential Medicines List (EML) concept functions in a high income country context.MethodsIn-depth qualitative semi-structured interviews were conducted with 32 Australian stakeholders, recognised as decision makers, leaders or advisors in the area of medicines reimbursement or supply chain management. Participants were recruited from government, pharmaceutical industry, pharmaceutical wholesale/distribution companies, medicines non-profit organisations, academic health disciplines, hospitals, and consumer groups. Perspectives on the definition and application of the EML concept in a high income country context were thematically analysed using grounded theory approach.FindingsStakeholders found it challenging to describe the EML concept in the Australian context because many perceived it was generally used in resource scarce settings. Stakeholders were unable to distinguish whether nationally reimbursed medicines were essential medicines in Australia. Despite frequent generic drug shortages and high prices paid by consumers, many struggled to describe how the EML concept applied to Australia. Instead, broad inclusion of consumer needs, such as rare and high cost medicines, and consumer involvement in the decision making process, has led to expansive lists of nationally subsidised medicines. Therefore, improved communication and coordination is needed around shared interests between stakeholders regarding how medicines are prioritised and guaranteed in the supply chain.ConclusionsThis study showed that decision-making in Australia around reimbursement of medicines has strayed from the fundamental utilitarian concept of essential medicines. Many stakeholders involved in medicine reimbursement decisions and management of the supply chain did not consider the EML concept in their approach. The wide range of views of what stakeholders considered were essential medicines, challenges whether the EML concept is out-dated or underutilised in high income countries.
Highlights
The concept of “essential medicines” dates back to military tradition, in which therapeutic supplies were essential to be carried by soldiers, field medics, and camp infirmaries, into combat zones
This study showed that decision-making in Australia around reimbursement of medicines has strayed from the fundamental utilitarian concept of essential medicines
Many stakeholders involved in medicine reimbursement decisions and management of the supply chain did not consider the Essential Medicines List (EML) concept in their approach
Summary
The concept of “essential medicines” dates back to military tradition, in which therapeutic supplies (such as penicillin) were essential to be carried by soldiers, field medics, and camp infirmaries, into combat zones. This was applied to the rationalising of therapeutic restrictions necessary during wartime economy [1]. The WHO’s Model List of Essential Medicines (WHO EML) includes 409 active substances, is updated every two years, includes low and high cost medicines, and is applied to all income settings in 156 countries [4,5,6]. The Access to Medicines Gap reported by the WHO states that one third of the world’s population still does not have access to medicines, which rises to up to half of the population in some LMICs [11,12]
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