A comparison of the essential medicines lists of the U.S. Department of Health and Human Services, the U.S. Department of Defense, the U.S. Food and Drug Administration, and the World Health Organization

Abstract

Background: An inability to obtain high-quality essential medications for U.S. warfighters constitutes a significant national security concern. An essential medicines list (EML) contains the medicines that a functioning health system must always have available to satisfy priority health needs.

Objective(s): A comparison of EMLs across U.S. agencies will facilitate focused decision-making for policymakers who are working to provide solutions to strengthen the U.S. pharmaceutical supply chain by highlighting the national and international competition for essential medicines.

Methods: We identified and obtained EMLs from the Department of Health and Human Services (2022), the Department of Defense (2023), the Food and Drug Administration (2020), and the World Health Organization (2023). Each EML was categorized to compare characteristics across EMLs. We then compared EML data between lists. Items that were present on all EMLs were classified as Tier 1 medicines and items that were present on any 3 EMLs were classified as Tier 2 medicines. We compared our list of Tier 1 and Tier 2 medicines with both the FDA and ASHP lists of current drug shortages as of May 9, 2025.

Results: We identified 25 Tier 1 medicines and 74 Tier 2 medicines. Nineteen Tier 1 medicines (76%) and 27 Tier 2 medicines (36%) were currently in shortage. Twelve Tier 1 and 8 Tier 2 medicines have formulations that have been in shortage for over 5 years.

Conclusion: For medicines essential for operational readiness, a secure domestic supply chain is vital to minimize risk to national security. Identification of these high-priority medicines are intended to facilitate focused decision-making for policymakers who are working to provide solutions to strengthen the pharmaceutical supply chain both within the DoD and throughout the U.S.