People with diabetes in low and middle income countries are not getting the choice of insulins they need, despite it being 100 years since this breakthrough product was discovered, says the Access to Medicine Foundation.
And while the big three, Eli Lilly, Novo Nordisk and Sanofi, have a “patchwork of strategies” to expand access, biosimilars could also hold the key to affordability, a report from the Foundation said, citing the Biocon example.
With innovative products, biosimilars and even heat-stable insulins in the pipeline, the world is at a moment in time when it can address the patient’s need for affordable insulin, Jayasree K Iyer, Chief Executive of the Netherlands-based Foundation told businessline. (Biosimilar drugs are highly similar to a biological product.)
The number of people with diabetes worldwide is expected to reach 643 million by 2030, rising most rapidly in low- and middle-income countries (LMICs) as the burden of non-communicable diseases grows, the report from the non-profit organisation said. India is home to the second highest number of people with diabetes (77 million), after China.
Insulin inequity
Outlining the prevailing insulin inequity, the report said, company efforts are currently fragmented, and often focused on a few countries, patient populations and products. As a result, they fall short of addressing the insulin inequity problem. Further, it added, LMICs should have access to analogue insulins, that result in improved control of blood sugar levels – making patients’ lives easier, reducing the risk of hypoglycaemia (low blood glucose levels), and potentially increasing adherence to treatment. “However, these products can cost over two to six times more than human insulins, with prices varying significantly between countries.”
Iyer also pointed to the need for health insurances and reimbursements to keep pace with the newer insulins, if indeed the product improved the patient’s quality of life. And while biosimilars from companies like Biocon will bring in greater affordability, the challenge was in the depth and scale required to get these products to the regions where it is required, she explained.
The World Health Organization (WHO) has added several analogues and their biosimilars to the WHO Model List of Essential Medicines in 2021; an indication that they should be available to patients in every country, the report noted. Recently, humanitarian organisation MSF (Medecins Sans Frontieres) had urged Indian authorities to include different formulations of insulin (including pen devices, insulin in cartridges, etc) and analogue insulins in the revised National List of Essential Medicines.
In fact, diabetologist Dr V Mohan in a podcast with this paper had also made an impassioned call for insulin to be made available to anyone who needs it. Especially so, since Frederick Banting and Charles Best, who discovered insulin, believed it was meant “for the world” and sold their patent for one dollar.
Barrier to access
Earlier this year, the United States House of Representatives had passed a bill to cap the price of insulin, reports said. While developed regions also reflect insulin-linked access and affordability problems, Claudia Martínez, ATM Research Programme Manager pointed out that the problem was more acute in LMICs, where the number of people with diabetes was increasing.
“Less than 30 per cent of low- and middle-income countries currently have access to all insulins deemed essential, with the cost of insulin being a huge barrier to access. Insulin products, particularly analogue insulins, need to become affordable to every payer. Tapping into the promising potential of biosimilar insulins, for example, could expand affordability and access,” she added.