Why Are We Failing to Address the Issue of Access to Insulin? A National and Global Perspective

Abstract

Insulin was discovered in 1921 and soon became widely available in high-income countries. However, many people currently in need of this life-saving medicine are unable to access it. This is a global phenomenon, impacting not only populations of low- and middle-income countries but low-income populations in the U.S. In the U.S., the rate of diabetic ketoacidosis remains high in certain subpopulations, the cost of insulin being the main precipitating factor. On a global level the main cause of mortality for a child with type 1 diabetes is a lack of access to insulin, and in sub-Saharan Africa the life expectancy of a child with type 1 diabetes can be as low as 1 year. One lens for considering the issue of access to health and medicines is to consider society as a three-legged stool. In this paradigm, the role of the public sector is to provide "protections" to the population it serves; the private sector is made up of "responsible businesses" that supply many of the goods and services people need; and the plural sector comprises communities and not-for-profits providing the "social affiliations" that are needed. For HIV/AIDS, each of these "legs" played a role in improving access. Civil society raised awareness of the issue and advocated for access to treatment. Governments provided funding and responses both nationally and globally. Finally, the private sector played its role, under pressure from civil society and governments, in lowering the price of medicines and developing programs to expand access. Here, we use this framework to describe the shortcomings in access to insulin from a U.S. and global perspective.

Production costs and potential prices for biosimilars of human insulin and insulin analogues

“…Recently price reductions as great as 70% have been seen for biosimilar infliximab. 39 Price reductions for the first insulin biosimilar available in the USA or Europe—a biosimilar of insulin glargine—have also arguably been modest (a second biosimilar has been approved in the European Union in the past few months, but pricing data are not yet available), 40 although large price reductions would not be expected with the first non-originator market entrant. As a point of comparison, the price estimated in this analysis for insulin glargine is about 60%–80% lower than prices of originator insulin glargine in high-income countries.…”

Costs and Its Drivers for Diabetes Mellitus Type 2 Patients in France and Germany: A Systematic Review of Economic Studies

“…Over time, several international studies dealt with the estimation of costs for treating diabetes (16)(17)(18)(19)(20)(21)(22)(23), pointing out several issues. Whereas in low-and middle-income countries, inadequate access to insulin (24,25) and oral drugs for controlling glucose and blood pressure represent the main bottleneck in type 2 diabetes treatment; in high-income countries, main problems concern with lifestyle and are related to nutrition, exercise habits and obesogenic living environments (26). Evidence demonstrated that type 2 diabetes is potentially reversible (27,28) and that early diagnosis and higher participation of patients in disease management could reverse current trends (29).…”

Safety and Effectiveness of an Investigational Insulin Delivery Device Providing Basal/Bolus Therapy with Rapid-Acting or Regular Human Insulin in Adults with Type 2 Diabetes

“…In the United States, many people struggle financially to support their insulin needs. [17][18][19] RHI is much less expensive than many rapid-acting insulin analogs, 17,18 and trial data suggest that patients with T2D may be appropriately controlled on human insulin. 17,20 Nonetheless, while rapidacting insulin products are approved for use in insulin pumps, 21,22 RHI is not approved or recommended for pump use according to manufacturers' drug labeling.…”