Revisión de la Lista Nacional de Medicamentos Esenciales en la República Dominicana

The list had not been updated since 2005, and various therapeutic groups and disease control programs had undergone partial revisions. However, a consolidated and validated national list was not established until 2015. The Ministry of Public Health requested technical assistance from the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program to update the LNME. SIAPS proposed a two-stage methodology for the review: (1) the revision of the existing national list (version 2005) and recent partial revisions by a pharmacoepidemiologist with international experience in reviewing essential medicine lists; and (2) the analysis of proposed inclusions, exclusions, or modifications made by professionals from institutions that form part of the National Commission for the Basic List of Essential Medicines (CNCBME), universities, specialized societies, and cooperation agencies. The pharmacoepidemiologist's initial task was to consolidate lists of medicines used by different institutions within the National Health and Social Security System and analyze the relevance of including each medicine based on national, regional, and international reference lists. For medicines whose inclusion was not supported by these lists or high-quality clinical studies, the consultant proposed exclusion or modification (e.g., replacing with a therapeutic equivalent). From a consolidated list of 1,039 medicines and their presentations, 467 (45%) were identified as not being in the reference lists, with proposals for exclusion, unless documentation supporting their retention was presented in the second stage of the process. In working meetings held in August 2014, professionals convened validated the majority of exclusion or modification suggestions and proposed the inclusion of medicines not considered in the pharmacoepidemiologist's proposal but included in national reference lists, protocols, or supported by evidence demonstrating a favorable benefit-risk ratio and cost-effectiveness. As a result of this consensus, a list of 762 medicines (437 active principles) was agreed upon, including 151 medicines without international reference list inclusion but with scientific evidence supporting their inclusion, and 39 medicines without evidence to support their inclusion but included in national norms or protocols and/or habitual use in the country. The initial consolidated list was reduced by 27%, from 1,039 medicines to 762 medicines. Medicines included in international reference lists increased from 64% to 82%. The revised LNME was approved by the CNCBME plenary session and ratified by a Ministerial Agreement in August 2015, endorsing it as a reference for public health sector medication acquisition and the supply of medications under the Basic Health Plan of the Social Security System.