What the revision of the WHO Essential Medicines List means for NCDs

In October 2025, the Lancet Commission on Accelerating Progress on Essential Medicines was launched to review new evidence on financing, sharing innovations, and measuring progress in access to essential medicines. Building on the 2017 Lancet Commission’s recommendations, this new commission will address new access-related challenges in a changed world, with findings expected in 2027, the 50th anniversary of the WHO Essential Medicines List (EML).

Just a month earlier, on 5 September 2025, the World Health Organization updated its 24th Model List of Essential Medicines, a critical global guide that has supported over 150 countries since 1977 to prioritize the most effective, safe, and affordable treatments. This update is especially timely as the upcoming Political Declaration from the Fourth UN High-Level Meeting on Noncommunicable Diseases (NCDs) and Mental Health (expected for adoption at the General Assembly) recommits countries to equitable medicine access, setting clear 2030 targets: at least 80% of primary healthcare facilities should have affordable access to WHO-recommended medicines and technologies for NCDs and mental health, and at least 60% of countries should have financial protection policies to shield patients from high costs of care.

Together, the Lancet Commission’s work, the WHO’s updated EML, and the UN Political Declaration provide both the tools and the mandate to accelerate access to essential medicines and to help governments use limited resources most effectively. This article dives into the latest EML revision, highlighting its potential to transform NCD treatment access worldwide and why swift action is vital to meet global health goals.

Why the EML matters for NCDs

Noncommunicable diseases (NCDs) are one of the most pressing global health challenges. Yet only 19 countries and territories are on track to meet the 2030 target of reducing premature deaths from NCDs by one-third. The burden falls disproportionately on low- and middle-income countries (LMICs), where 82% of premature NCD deaths occur, and health systems face resource constraints.

The WHO EML helps governments tackle this challenge by offering an independent, evidence-based assessment of medicines. Once priority conditions are identified, the EML guides decision-makers in selecting the most effective, safe, and affordable treatments for their national context.

This function is especially critical for NCDs, where multiple treatment options often exist and choices must carefully weigh clinical effectiveness, safety, and cost to maximize health impact.

NCDs at the forefront of the 2025 revision

The 2025 update to the WHO Model List of Essential Medicines includes significant new additions across cancer, diabetes, cystic fibrosis, tobacco cessation and sickle cell disease.

Cancer: New treatments for leukemia, lung, cervical, and colorectal cancers were added, along with therapeutic sunscreen for people with albinism to prevent skin cancer. While the WHO EML is a global reference for national cancer treatment policies, only 8% of countries have aligned their national lists with WHO cancer medicine recommendations. Beyond listing, many LMICs also struggle with high costs, limited diagnostic capacity, and weak supply chains.

Diabetes: Rapid-acting insulin analogues have been added to complement the long-acting insulins listed in 2021, offering patients greater flexibility and improved glycaemic control.

Cystic Fibrosis: For the first time, the triple therapy elexacaftor + tezacaftor + ivacaftor (Trikafta) was added to adult and children’s lists. Cystic Fibrosis (CF) is a rare genetic condition affects around 160,000 people worldwide, many children. While Trikafta can dramatically improve and extend lives, it is also prohibitively expensive, with only around 28% of patients worldwide able to access treatment [1].

Tobacco Cessation: The addition of cytisine, a plant-based smoking cessation medicine, marks an important milestone in tackling one of the leading preventable causes of NCDs. By reducing smoking satisfaction and counteracting withdrawal symptoms, cytisine offers an effective tool to help people quit smoking. Its inclusion in the EML underscores the need for affordable, accessible and evidence-based cessation treatments as part of global public health strategies, and reinforces countries' commitments under the WHO Framework Convention on Tobacco Control (Article 14) and the WHO MPOWER package, which calls on countries to scale up accessible cessation support.

Sickle cell disease: Hydroxyurea (hydroxycarbamide) was added to the 2025 WHO Essential Medicines List for Children, reaffirming its role as a core disease-modifying treatment. The Committee also made changes to Section 10.3 (Other medicines for haemoglobinopathies) of which hydroxyurea is a part, to clarify the specific conditions and recommended use for each medicine, including by creating a separate sub-section for sickle-cell disease.

Glucagon-Like Peptide-1 Receptor Agonists (GLP-1s)

GLP-1s, known widely as the “obesity drug,” were originally developed to manage type 2 diabetes but have gained major attention for their role in treating obesity. These medicines are now on the WHO EML, recommended for adults with type 2 diabetes who have (i) cardiovascular or chronic kidney disease, and (ii) obesity. They are not listed for obesity alone due to limited long-term safety and efficacy data; WHO has now developed obesity-specific guidelines, which may lead to future inclusion.

Widely used GLP-1 agents such as semaglutide, liraglutide, and tirzepatide, show potential benefits beyond diabetes, including for cardiovascular and kidney diseases, fatty liver, sleep apnea, alcohol-related harms, addiction, and mental health.

Addressing obesity requires a comprehensive approach, with GLP-1s representing one part of the overall picture. Both diabetes and obesity demand treatment strategies that combine healthy diets, physical activity, and ongoing clinical support to achieve sustainable results. Not all patients respond to these medicines; many require long-term treatment, and some need to maintain muscle while losing fat.

Equitable access is a major challenge: high costs and rising demand have caused shortages and raised concerns that GLP-1 production may compete with other essential medicines like insulin.

Inclusion on the EML signals global recognition of GLP-1s’ importance, but improving access depends on national action: updating national essential medicines lists and guidelines, registering products, ensuring affordability, training health workers, and securing supply chains.

The 2025 revision also reflects strong engagement from the NCD community. The NCD Alliance (NCDA) participated in the open session of the 25th WHO Expert Committee on the Selection and Use of Essential Medicines in May 2025, contributing a joint statement with partner organizations to emphasize the urgency of improving NCD medicine access and aligning global and national priorities.

What this means for countries

The 24th WHO EML revision is more than an administrative update; it is a powerful advocacy tool. By standardizing treatment, national EMLs help countries prioritize effective interventions and optimize limited health resources. The inclusion of NCD medicines is crucial, and a strong lever for improving access.

Alongside the upcoming Political Declaration and the Lancet Commission’s forthcoming recommendations, governments have a clear framework to expand equitable access to essential medicines for NCDs. Advocates need to act swiftly to push for updated national EMLs, and work with stakeholders to strengthen procurement and supply and decrease out-of-pocket payments, ensuring people everywhere can benefit from essential medicines without facing financial hardship or shortages.