Comparison of essential drug lists: concordance, differences, and the need for core lists in times of crisis

The prioritization of essential drugs is important for rational pharmacotherapy, public health, drug availability, and medical education. While the Model List of Essential Medicines (EML) of the World Health Organization (WHO) is considered the international reference, other drug lists focus on supply-related or educational purposes. Seven drug lists were compared. Drug names were extracted, harmonized, and analysed for their presence on each list. Assessed were the number of listings per drug, the concordance between the lists, and the comparison of the EML 2025 with other lists. In addition, frequently prescribed drugs in Germany were compared with the summarized drug list. In total, 1061 single drugs were identified. Most drugs were listed on one to three drug lists (n = 824; 77.6%), whereas 49 drugs were listed on six or seven lists. These highly concordant drugs mainly covered broad-use symptomatic care, long-term treatment of chronic disorders, and emergency situations. Several frequently prescribed drugs and relevant indication areas were not represented within the highly concordant core. Essentiality strongly depends on the purpose, scope, and regional context of a drug list. Broad concordance can support the relevance and recognition of established drugs across different contexts, but does not prove therapeutic value or essentiality. Therefore, comparison with other drug lists provides an additional perspective, but should be combined with drug-specific assessment of therapeutic value, safety, prescription relevance, feasibility, and global need. Especially in times of crisis, effort is needed for the development of national and international core essential drug lists.