Impact of National List of Essential Medicines (NLEM) on Cost Variation of Immunosuppressants available in Indian Market

Background: Immunosuppressants are used commonly in two conditions: to prevent graft versus host rejection in transplantation and autoimmune disorders. Autoimmune diseases are chronic in nature requiring lifelong treatment. Organ transplantation is also expensive. Therefore, affordability of these medicines is crucial. To address the problem of affordability, government caps the prices of drugs included in National List of Essential Medicines. However, even cost variation among various brands of the drugs included in essential medicine list is of concern as majority of prescriptions are written using brand names. Hence this study was undertaken to evaluate impact of essential medicine list on cost variation of these drugs. Materials and Methods: Immunosuppressant drugs were broadly classified into two categories – drugs listed under National List of Essential Medicines and drugs not included. Prices of the drugs belonging to both the groups were obtained from website “Pharma Sahi Dam”. Later, cost ratio, percentage cost variation was calculated. The multiple linear regression analysis was performed to investigate association between percentage cost variation and essentiality/number of brands. Results: Immunosuppressant drugs showed wide cost variation. Overall higher cost variation was seen among drugs not included in essential medicine list. This was further substantiated by multiple regression analysis (β = 0.316, p = 0.021). However, number of brands had no effect on cost variation. Conclusion: Hence, to improve affordability of these drugs which are mainstay in autoimmune disorders and organ transplantation, regulatory bodies should widen the inclusion criteria for essential medicine list. Also, efforts are needed to create awareness of cost variation among prescribers.