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Médecins Sans Frontières (MSF) welcomes the analysis of the cost of manufacturing of human and analogue insulins by Gotham and colleagues. This work provides a realistic estimate of significantly lower market prices that would be more affordable for both governments and individuals and should open the eyes of the global health community to the shameful reality of abusive pricing as well as the gross inequity in access to treatment for people living with diabetes.
In resource-limited settings, access to insulin is centralised and rarely free of charge within the public health system. For those who can access insulin, many must travel once or often twice daily to a clinic to receive their injections, due to fears around home storage of phials and self-injecting - particularly in conflict-affected or insecure settings.
Human insulin is the only type of insulin included on the WHO Essential Medicines List (EML), and when procured in phials, costs significantly less than analogue insulin or insulin within an adapted device (cartridge or pen) which may simplify delivery. Debates continue around the impact of analogue insulins on diabetes outcomes (HbA1c), but many experts recognise that access may make regimens safer, particularly in settings where MSF works.
The market dominance of and excessive pricing by the three major human and analogue insulin producing companies - along with the lack of competition from biosimilar manufacturers to challenge this d...
The market dominance of and excessive pricing by the three major human and analogue insulin producing companies - along with the lack of competition from biosimilar manufacturers to challenge this dominance - has contributed to the reality that worldwide at least 50% of those in need of insulin are not able to access this life saving treatment. As Gotham and colleagues’ work clearly outlines, the cost differentials in manufacturing a phial of human insulin ($2.28 – $3.42) versus analogue insulin ($3.69 - $6.16) are not reflected in current market prices. Indeed, insulin prices around the world lie far above these ranges, with often excessively high price differentials between human and analogue. The abusive pricing strategies of pharmaceutical corporations must be challenged in light of the limited access globally, and in low income and humanitarian settings in particular.
The majority of insulin that MSF procures is human insulin in phials, from Lily and Novo Nordisk, two of the three insulin market dominators. Activism by people living with HIV, MSF and other advocates for affordable generic antiretrovirals (ARVs) and a coordinated donor response resulted in over 20 million people currently receiving treatment for HIV. The current lack of competitive biosimilar insulins – similar to the lack of generic ARVs 20 years ago – is a huge hurdle to overcome in ensuring access for people living with diabetes today. Regulatory pathways for biosimilars and lack of transparency across price negotiations are just two of the factors challenging competition in the insulin market.
People living with diabetes need insulin today, and the lack of access in 2018 is an outrage. MSF supports a coordinated global response to ensure quality, affordable human and analogue insulin formulations are available in adapted delivery devices for people in need of this life-saving treatment.