New diabetes medicines and insulin pens are priced multiple times higher than the cost of production, putting the product beyond the reach of patients, says a costing study by Doctors Without Borders/Médecins Sans Frontières (MSF).

The study was published in the Journal of the American Medical Association (JAMA) Network Open, on Wednesday. Alleging “exorbitant corporate profiteering”, MSF called for policymakers, governments and procurers to act on the study findings, which could impact affordability of diabetes treatments for people in low- and middle-income countries (LMIC), as well, they said.  

The study’s first finding involved a newer class of drugs, GLP-1s, including Ozempic and Trulicity marketed by pharmaceutical companies Novo Nordisk and Eli Lilly, respectively. MSF’s study estimates “that GLP-1s for diabetes could be sold at a profit for just $0.89 per month, compared to the price of $95 per month charged in Brazil, $115 per month charged in South Africa, $230 charged in Latvia and $353 charged in the US, which is a 39,562 per cent markup over what the estimated generic price could be,” MSF said.

Drug pricing

MSF representatives explained, the cost of production was calculated on what the price could be to make these medicines, as outlined in their paper.

Novo Nordisk and Eli Lilly are the only producers of these GLP-1s, and ” their intellectual property barriers on the drugs and injection devices block any generic manufacturing that could help drive prices down,” MSF said.

The corporations have not announced an LMIC price, nor have they licensed these drugs so generic manufacturers could make them, helping meet global demand and drive prices down. The companies are unable to meet the demand for these drugs in high-income countries too, given that they are additionally used for weight loss as well, – meaning people living with diabetes cannot access them, MSF said. 

The study was published close to going to press, so both companies could not be reached for an immediate comment.

In India, companies sell products at an India-specific pricing. Nishtha Kanal, who is on oral semaglutide told businessline, that the drug has helped control her sugar and weight. At ₹10,000 a month, semaglutide was added to her diabetes bill that includes other oral drugs, insulin and a bio-sensor, to monitor her sugar levels. Prices have to be reduced and generic versions need to come in, she said, so more people can access newer drugs.

Access barrier

Christa Cepuch, Pharmacist Coordinator at MSF’s Access Campaign, points out, “These new drugs are an absolute game changer for people living with diabetes, but are being kept out of the hands of hundreds of millions of people in low and middle income countries who need them.”

Nupur Lalvani, with patient-led Blue Circle Diabetes Foundation, has been on insulin for 29 years and finds that generic versions are not available for the newer insulins. Costs are prohibitive on the new devices, she said, and patients are paying out of pocket, she added, calling for these products to be included in the Government’s Jan Aushadhi Kendras.

In fact, the MSF study’s second finding involved the insulin pen injection devices, preferred by people living with diabetes over using multiple syringes each day to inject insulin out of vials. It is also safer with increased dosing accuracy, important for people living in unstable or crisis contexts where access to glucose monitoring is less assured and health care options are limited for those who develop diabetes complications it said.

But due to its high prices, insulin pens are almost never available to people in LMICs and are not often used by humanitarian agencies, it said.

MSF’s study found that “one pre-filled human insulin pen could be sold at a profit, at an estimated generic price of just $0.94, compared to the $1.99 price in South Africa, $5.77 in India, $14 in the Philippines and $90.69 in the US. A long-acting pre-filled analogue insulin pen could be priced at $1.30 each, compared to the price of $3.00 charged in South Africa, $7.90 in India, $25.20 in the Philippines and $28.40 in the US – a 2,153 per cent markup.”

This meant that insulin pens could be more affordable compared to the older and less user-friendly vials, if the corporations making them would reduce their prices.

The Insulin pen devices and long-acting insulin analogues have recently been included in the WHO’s Essential Medicines List, which is used by countries to prioritise their own essential medicines lists and procurement plans. 

Diabetes affects 537 million people globally, and only half of the people who need insulin in the world have access to it, the note said.