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To cite: Satheesh G, Unnikrishnan MK, Jha V, et al. BMJ EvidenceBased Medicine Epub ahead of print: [please include Day Month Year]. doi:10.1136/ bmjebm-2022-112171 © Author(s) (or their employer(s)) 2023. No commercial reuse. See rights and permissions. Published by BMJ. Essential medicines—defined by the WHO as ‘those that satisfy the priority health care needs of the population’—are meant to be always accessible within health systems, in sufficient quantities, in optimal dosage forms, of guaranteed quality and at affordable costs. The WHO Model Essential Medicines List (EML) serves as a reference for countries to design and update national EMLs to support medicine procurement, supply, manufacture, pricing and prescribing practices. In this commentary, we discuss the gaps, strengths and opportunities in evidencebased decisionmaking in India’s latest national EML, highlighting potential lessons for the future and for other countries. India’s first National List of Essential Medicines (NLEM) was released in 1996, following which it has been revised four times: in 2003, 2011, 2015 and most recently in 2022, after a gap of 7 years. Within this gap between NLEM2015 and NLEM2022, the WHO revised its EML three times (every 2 years), and each revision comprised 90 modifications on average. Unlike the WHO, many countries fail to update national EMLs regularly (see figure 1), in response to changing healthcare demands, mounting scientific evidence and local disease burdens. These delays have potential implications, particularly in low resource settings, because including a medicine in the EML leads to price control, increased prescribing and consequently, improved access and affordability. India faces a dual burden of infectious diseases and noncommunicable diseases. Despite cardiometabolic conditions being the leading cause of death and disability in India—significantly affecting Indians’ most productive years— the proportion of patients receiving optimal care remains alarmingly low. 4 Poor access to essential medicines is among the major barriers to optimal care; suboptimal availability of medicines in the public sector, the sole source of freeofcost medicines, drives patients to the expensive private sector, which often proves unaffordable for poorer groups. Public sector procurement can be improved by EMLs, but the NLEM2022 falls short of being ‘evidencebased’, notwithstanding its aim to prioritise ‘need, safety, efficacy and cost effectiveness’ (online supplemental table S1).