Insulin Access and Affordability in Diabetes Care

Insulin remains an indispensable therapy for people with type 1 diabetes and many with type 2 diabetes, yet its availability and cost present persistent global challenges. The market is dominated by a small number of multinational manufacturers, creating supply-chain vulnerabilities and limiting competition. High mark-ups and patent protections have kept prices elevated in numerous settings, while weak procurement policies and limited regulatory harmonisation hinder the entry of lower-cost alternatives. In high-income countries many patients face rising insurance premiums and copayments, leading to occasional rationing of doses. In low- and middle-income countries, out-of-pocket expenditures can consume a substantial fraction of household income, resulting in treatment interruptions and avoidable complications. Strategic initiatives—such as inclusion of insulin in international prequalification programmes, pooled procurement mechanisms, tiered pricing, promotion of biosimilar manufacture and prescribing, and targeted subsidies—have shown promise in reducing prices and improving supply stability. Strengthening national policies on selection, procurement, distribution and reimbursement of insulin, along with bolstering primary-care delivery and patient education, is critical to ensure universal, equitable access and to mitigate the humanitarian and economic burdens of diabetes worldwide.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Insulin Access and Affordability in Diabetes Care publication trend

The graph below shows the total number of articles in insulin access and affordability in diabetes care across all publications each year (not limited to Nature Index journals).

Technical terms

Analogue insulin: A modified insulin molecule engineered to alter absorption kinetics or duration of action in comparison with unmodified human insulin.

Biosimilar insulin: A biologic product that is highly similar to an existing approved insulin, demonstrating no clinically meaningful differences in safety, purity or potency.

Median Price Ratio (MPR): A metric expressing the median local price of a medicine relative to an international reference price, used to assess affordability and price regulation.

Out-of-Pocket Expenses: Direct payments made by patients for insulin and related supplies, excluding amounts reimbursed by insurance or public programmes.

References

1. A global perspective on the issue of access to insulin. Diabetologia (2021).
2. Costs and underuse of insulin and diabetes supplies: Findings from the 2020 T1International cross-sectional web-based survey. Diabetes Research and Clinical Practice (2021).
3. Access to insulin: applying the concept of security of supply to medicines. Bulletin of the World Health Organization (2019).