North Macedonia’s essential medicines list updated with 193 new drugs

North Macedonia has approved a new list of essential medicines, ending a period of more than a decade without changes. The document sets out the medications that healthcare professionals must always have available for patient care.

The revised list contains a total of 372 medicines, 193 of which are entirely new additions. It is organized into 28 therapeutic areas and specific subdivisions, making it more intuitive and practical to use in clinical settings.

A key innovation is the inclusion of explicit guidance for cases in which a medicine is unavailable, specifying therapeutic alternatives that can serve as suitable substitutes. The classification of antibiotics has also been changed, with the medicines now divided into three subcategories. The list also addresses therapeutic areas that were previously not covered, including multiple sclerosis, cystic fibrosis, modern treatments for HIV, hepatitis B and C, as well as oncology therapies.

During the presentation ceremony, Health Minister Sasho Klekovski pointed out that the update was unavoidable, given that the World Health Organization has carried out several significant reviews of its essential medicines list over the past 11 years. He explained that the national document is the product of an inclusive process within the National Medicines Platform, involving institutions, field experts and patient representatives.

Beyond treatment, the new list also emphasizes preventive measures. For the first time, it includes nicotine replacement therapy, which, according to Minister Klekovski, aims to strengthen the preventive approach to diseases, including lung cancer.

Minister Klekovski insisted that another decade must not be allowed to pass without updating the list. “It is essential to create a mechanism for periodic reviews,” he said, adding that changes are not necessary every six months or every year, but should reflect major revisions to the WHO list. According to him, when the WHO makes significant updates, they should be incorporated into domestic legislation without delay.

Dr. Akeem Ali, the World Health Organization’s representative in the country, supported this approach. He said that formalizing regular updates to the list through the new Law on Medicines would be crucial to keeping it continuously up to date and aligned with patients’ real needs. Dr. Ali also stressed that a sustainable review mechanism is essential for the accountability of the healthcare system and for fostering public trust.