OBJECTIVES: Our major objective of the study was to assess the budgetary outcome of implementing the first Hospital Essential Medicines List (HEML) 2011 with a revised purchase policy in a rural resource limited, district charity hospital in India. HEML was also compared with national and World Health Organization (WHO) EMLs. METHODS: Expenditure on medicines purchase for the year of 2010 was compared for the year 2011 (after the first HEML and revised purchase policy). Evaluations were done to compare the number of medicines, dosage forms and fixed drug combinations of tablets and injections. Microsoft Excel 2007 was used to process the results. RESULTS: There was approximately 40 % reduction in the money spent on medicines in 2011 when compared to 2010, which was approximately nine crores of Indian Rupees (approximately 1.7 Million US Dollars). The number of medicines in 2010 was 1627, which was reduced to 424 in HEML 2011. WHOEML 2011 has 350 and National Essential Drugs List (NEDL) 2011 of India has 348 medicines. While preparing the HEML, 31 tablets and 14 injections of two-drug fixed combinations were removed. The great reductions were; 51 ointments to 9, 69 drops to 5, 11 paste to 0, 21 solutions to 3 and 14 creams to 1. The dosage forms removed include elixir, insulin pen, gums, paste, paint, gargle, mouthwash. CONCLUSIONS: New purchasing policy and implementation of HEML were the crucial factors in the cost minimization, in our charitable hospital. The WHOEML 2011, NEML 2011 and the HEML 2011 were comparable with few exceptions. Healthcare policy makers should note that, use of WHOEML and NEML with local experience makes implementation of HEML more practical in the countries with limited professional resources.