Only two of 10 access plans for late-stage diabetes drug projects included equitable pricing measures, the Access to Medicine Foundation found, raising concerns about whether new treatments will reach patients in lower-resource countries.
The foundation reviewed 19 late-stage projects for its 2026 Access to Medicine Index and found access plans for 10. Its broader assessment counted 25 diabetes research projects across six companies. Eighteen involved incretin or other metabolic hormone approaches for type 2 diabetes, while 10 targeted type 1 diabetes. Those groups overlap within the 25-project total. The Index covered June 1, 2024, through May 31, 2026.
The foundation said access efforts for newer GLP-1 medicines are concentrated in a small number of commercially attractive middle-income markets. It also said limited information on prices and supply volumes makes it difficult to judge how many patients benefit.
Insulin access poses a separate challenge. Eli Lilly and Company, Novo Nordisk and Sanofi account for more than 90% of the global insulin market, according to the foundation. People with type 1 diabetes need insulin to survive. The World Health Organization identified high prices, limited availability, concentrated supply and weak health systems as barriers to access in a 2021 report.
Regulators have documented changes to some existing products. The European Medicines Agency said Novo Nordisk will discontinue specified insulin products or presentations in affected European markets before the end of 2026 for commercial reasons. Australia’s Therapeutic Goods Administration said Novo Nordisk and Eli Lilly are discontinuing some products or presentations. The Australian regulator said another form will remain available for several affected products, but it expects no Levemir or insulin detemir products on the market from 2027.
Novo Nordisk says its Access to Insulin Commitment covers 77 countries. The program sets a ceiling of $3 per vial of human insulin in eligible countries and $2 per vial for qualifying humanitarian organizations.
The International Diabetes Federation estimated that 589 million adults ages 20 to 79 lived with diabetes in 2024, including 81% in low- and middle-income countries. In a separate foundation essay, chief executive Jayasree K. Iyer wrote that diabetes access plans “fall short” on equitable pricing and registrations in low-resource settings.
The foundation called for measurable commitments to maintain affordable insulin supplies and for companies to report prices, volumes and the geographic reach of manufacturing partnerships.
