The WHO Model Formulary isn’t a list of drugs you’ll find on a pharmacy shelf. It’s the world’s most trusted guide for which medicines every health system - no matter how poor or remote - should have available. Developed by the World Health Organization, it’s not about luxury treatments or cutting-edge biologics. It’s about the bare minimum: life-saving, affordable, proven generic medicines that work for the most common and deadly diseases. In 2023, the 23rd edition listed 591 medicines, and nearly half of them - 273 - are generics. That’s not an accident. It’s the core strategy.
Why Generics? The Math Behind Global Health
Generic drugs aren’t second-rate. They’re identical in active ingredient, dosage, and effect to brand-name drugs - but cost 80-95% less. For a country like Ghana or Nepal, that difference means the difference between treating 1,000 people with hypertension or 100. The WHO doesn’t pick medicines based on profit margins or marketing. It picks them based on hard data: proven safety, clear effectiveness, and cost-per-life-saved. A medicine must show it works in rigorous clinical trials, treats a disease affecting at least 100 people per 100,000, and offers better value than alternatives. If a generic meets those bars, it’s in.
The results are real. Since 2008, the price of generic HIV antiretrovirals has dropped from $1,076 per patient per year to just $119. That’s why, in 2022, nearly 30 million people living with HIV were on treatment - up from 800,000 in 2003. That’s the power of the WHO’s focus on generics.
How the List Works: Core vs. Complementary
The WHO Model List isn’t one big pile of drugs. It’s split into two parts. The core list has the absolute essentials - medicines that work with basic equipment, no specialist needed. Think antibiotics for pneumonia, insulin for diabetes, or antimalarials for children. These are the backbone of primary care clinics in villages without electricity.
The complementary list includes medicines that need more support - like cancer drugs requiring lab tests, or epilepsy meds needing specialist monitoring. These aren’t less important. They’re just harder to deliver. The list makes it clear: if your health system can’t handle the monitoring, start with the core. Build capacity. Then add more.
This isn’t just theory. Over 150 countries have built their own national lists based on this structure. In India, the National List of Essential Medicines follows the WHO model closely. Pharmacists there report a 35% drop in antibiotic costs after switching to WHO-recommended generic tiers. In Ghana, out-of-pocket spending on medicines fell 29% between 2018 and 2022 after adopting the list.
Quality Isn’t Optional - It’s Mandatory
Not all generics are created equal. That’s why the WHO doesn’t just say “use generics.” It says: use generics that pass WHO Prequalification. This means the drug has been tested for purity, potency, and how well it’s absorbed by the body. Bioequivalence studies must show the generic performs within 80-125% of the original brand - and even tighter for drugs like warfarin or lithium, where small changes can be dangerous.
Ninety-two percent of the generic medicines on the 2023 list require this prequalification. It’s not a suggestion. It’s a requirement for any country buying through UN agencies like the Global Fund. That’s why manufacturers in India and China are rushing to get their products certified - 47% more prequalified generics were added between 2018 and 2023.
But the problem isn’t always the medicine. It’s the supply chain. A 2022 survey in Nigeria found only 41% of essential medicines were consistently available. Stockouts averaged 58 days per drug. That’s not because the WHO list is wrong. It’s because logistics, funding, and corruption broke the system. The list can’t fix that - but it can help countries demand better.
What the WHO List Doesn’t Do
It doesn’t tell hospitals which drugs to stock. It doesn’t set copays or insurance tiers. It doesn’t include every new drug on the market. In fact, only 12% of new medicines approved between 2018 and 2022 made it into the 2023 list. That’s by design. The WHO isn’t chasing the latest fad. It’s focused on what saves the most lives with the least money.
Compare that to the U.S. Medicare Part D formulary, which must include at least two drugs in each of 57 therapeutic categories - even if one is clearly better. Or private insurers that push expensive brand-name drugs to boost profits. The WHO list has no tiers, no copays, no marketing influence. It’s just: what works? What’s safe? What’s affordable?
That’s why only 22% of U.S. hospital pharmacists consult the WHO list regularly. For them, local compendia like Micromedex are more practical. But for a clinic in rural Malawi? The WHO list is the only reliable guide they have.
Challenges and Criticisms
Even the best systems have flaws. Some experts worry the WHO is too slow to add new medicines. Others point to the fact that 45% of the evidence used in the 2023 review came from industry-funded trials - up from 28% in 2015. That raises questions about independence. The WHO says it now requires full financial disclosures from its expert committee - and 100% compliance was reported in 2023.
Another issue: pediatric doses. Many essential medicines on the list don’t have child-friendly formulations - like syrups or smaller tablets. In low-income countries, parents often crush pills or guess dosages. The 2023 list tried to fix that: 42% of medicines now have age-appropriate forms, up from 29% in 2019. But there’s still a long way to go.
And then there’s the concentration of production. 78% of global generic medicine manufacturing happens in just three countries: India, China, and the U.S. When the pandemic hit, 62% of low-income countries faced shortages of key antibiotics. The WHO knows this. That’s why it’s now pushing for more regional manufacturing hubs - especially in Africa and Southeast Asia.
What’s Next? The Road to 2030
The WHO isn’t resting. In 2023, it launched a free app for health workers - downloaded over 127,000 times in 158 countries. It’s helping pharmacists and nurses choose the right generic at the point of care. It’s also working with countries to link medicine access directly to Universal Health Coverage goals. The target? Get essential medicine availability in primary care from 65% to 80% by 2030.
There’s also new guidance on antibiotic stewardship. Instead of just listing antibiotics, the WHO now wants health systems to classify them into tiers - reserve, preferred, restricted - to slow down resistance. That’s a big shift from just making drugs available to making sure they’re used right.
And funding? Only 31% of low-income countries spend more than 15% of their health budget on medicines - the level the WHO says is needed to make the list work. Without that investment, even the best list is just paper.
The Real Impact
The WHO Model Formulary doesn’t make headlines. It doesn’t have flashy ads or celebrity endorsements. But it’s quietly saving millions of lives every year. It’s the reason a child in Bangladesh can get antibiotics for pneumonia. It’s why a mother in Uganda can get insulin for her diabetic son. It’s why a person living with HIV in rural Zambia can take the same pills as someone in London - and pay a fraction of the cost.
This isn’t about global bureaucracy. It’s about fairness. The WHO Model Formulary says: your life-saving medicine shouldn’t depend on where you were born. It’s not perfect. It’s not always easy to implement. But it’s the closest thing we have to a global promise - that no one should die because they couldn’t afford a pill.
Is the WHO Model Formulary the same as a national formulary?
No. The WHO Model Formulary is a global recommendation - a list of which medicines every country should aim to have. A national formulary is what a specific country actually uses, including rules on prescribing, cost-sharing, and which brands are approved. Most countries use the WHO list as a starting point, then adapt it to their budget, supply chain, and disease patterns.
Are all generics on the WHO list safe?
Only those that meet WHO Prequalification standards. These generics have been independently tested for quality, strength, and how well they’re absorbed by the body. They must match the original brand within strict limits. If a generic isn’t prequalified, the WHO doesn’t recommend it - even if it’s cheap.
Why doesn’t the WHO list include more new drugs?
The WHO prioritizes medicines that save the most lives at the lowest cost. New drugs are often expensive and lack long-term safety data. The list focuses on proven, affordable options - not the latest innovation. Only 12% of new drugs approved between 2018 and 2022 made it onto the 2023 list. The goal is universal access, not access to the newest tech.
Can high-income countries use the WHO Model Formulary?
Yes - but not usually for domestic care. U.S. and European hospitals rarely use it for their own formularies. But it’s widely used by global health programs, NGOs, and agencies like UNICEF and the Global Fund. It’s also a benchmark for evaluating whether a country is overpaying for medicines or relying too much on expensive brands.
How often is the WHO Model Formulary updated?
Every two years. The most recent update was in July 2023. The next one is expected in 2025. A committee of 25 independent experts from 18 countries reviews new evidence and decides which drugs to add, remove, or change.
What You Can Do
If you’re a patient, ask your pharmacist if your medicine is a generic - and if it’s from a trusted source. If you’re a health worker, use the WHO Essential Medicines App to guide your choices. If you’re a policymaker, push for funding to match the WHO’s recommended 15% of the health budget. And if you’re just someone who cares about global health - know that this list exists. It’s not perfect. But it’s the best tool we have to make sure no one is left behind because they can’t afford a pill.
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