Addressing insulin affordability on-patient drugs access in Nigeria

One of the major problems experienced by people living with diabetes is the affordability and supply of insulin drugs. This has been manifested by the large number of Nigerians who lack access to quality meds and the others who are left languishing in poverty after paying for them.

This situation is largely due to the high prices paid for these drugs making them unaffordable despite the fact that health should be a basic need afforded by everybody.

Although there has been immense championing for access and price reduction by manufacturers and accelerated production and availability of insulin drugs through innovation, these drugs still remain unaffordable.

The burden of treatment of diabetes remains significantly greater in Nigeria and other low-and medium-income countries (LMICs). There are currently about 3.5million adults that live with diabetes in Nigeria, which observers insist, is probably understated due to poor diagnosis in many African countries. Nevertheless, it’s expected to grow and reach 8 million by 2045.

However, the health expenditure related to diabetes care in Africa is about $12.5 billion dollars. Preventative efforts, as well as screening, diagnosis, referrals, lifelong daily treatment, and monitoring for all people with diabetes at various levels of the healthcare system, cannot be overemphasised.

Given this situation, what really makes up for the costs of these drugs are associated with the prevalence of the disease which is not only social but economic. The price paid by the patients is a function of the manufacturer’s price on one hand and the mark-ups of importers, wholesalers, and retail pharmacies plus other dispensing fee on the other.

A condition which is even worse in emerging markets like Nigeria where the supply chain is fragmented and average diabetes-related health expenditure per person amounts to approximately $500 dollars a year, which is a huge financial burden if the patient has to pay it all or partially out-of-pocket. This significantly increases the markup costs.

Insulin is the cornerstone of diabetes treatment for all patients with type 1 diabetes and many of those with type 2. Insulin was discovered 100 years ago, transforming type 1 diabetes from a certain death sentence into a treatable long-term condition. Yet, this transformation has been far from universal.

Insulin is estimated to be needed by over 72 million people, including 9 million people living with type 1 diabetes and approximately half of the people living with type 2 diabetes who need insulin worldwide are actually receiving treatment.

Global insulin inequity is stark

To deal with the access and affordability challenges, companies are now seeking sustainable ways to scale up access and taking actions to address the inequity to this essential medicine.

Eli Lilly, Novo Nordisk, and Sanofi are the three companies that dominate the global insulin market. They are pursuing a patchwork of strategies to expand access to their products in LMICs. These include; pediatric programmes, price ceilings, and equitable pricing policies.

According to a new report by the Access to Medicine Foundation, and also Biocon, a major manufacturer of biosimilar insulins, the number of people with diabetes worldwide is expected to reach 643 million by 2030, and 783 million by 2045, rising most rapidly in low- and middle-income countries as the burden of non-communicable diseases grows.

Analysis of the report by Access to Medicine Foundation (ATMF), a Netherlands-based non-profit organisation that stimulates and guides pharmaceutical companies to do more for people living in low and middle-income countries, shows that these companies are taking steps to make their products available in LMICs, yet poorer populations are being consistently overlooked when it comes to the registration of insulin.

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The report indicates that 35% of patients in LMIC pay out-of-pocket for healthcare, compared to 13.6% in high-income countries, where the public sector is more likely to be involved.

In some LMICs, the variety of types of insulins available is very limited. Only 29 of the 108 countries in scope have all the insulins classified as “essential medicines” by WHO registered, and only one of those is a low-income country. Worse, in 24 countries, no insulins were found to be registered at all. When even this initial step towards access has not been taken for any insulin products, the situation for those who need insulin to survive is very grave indeed.

The ATMF report examined the activities of 3 pharmaceutical manufacturers. It showed that Eli Lilly, Novo Nordisk, and Sanofi, produce 83% of the insulin sold in LMICs, where they also hold around 95% of the market share. Insulin supplied by these firms is sold at higher median prices in LMICs than in high-income countries. According to the report, the reasons for this include; the manufacturer’s selling price, wholesale and retail mark-ups, taxes, and other tariffs.

These companies are however, taking actions to address the inequity in access to this essential medicine. “In Nigeria, Novo Nordisk has signed a memorandum of understanding with the Federal Ministry of Health, and that serves as a base for the rollout of a programme called I-Care,” says Dr. Jayasree Iyer, CEO of Access to Medicine Foundation.

The idea of this programme, Iyer adds is to provide affordable access to diabetes care, especially for children with type 1 diabetes.

According to her, “SANOFI, another large insulin provider has pushed for the listing of insulin in the National Health Insurance Authority (NHIA) and the State Health Insurance Scheme for two of Nigeria’s 36 states. These actions help to make insulin more affordable and accessible to more people. The company is planning to expand this strategy to two more states in 2022.”

Iyer noted that lack of access to insulin is a devastating problem for diabetes patients globally. however, to achieve long-term improvements and ensure that patients have access to the best available treatments, government must step up efforts to ensure that successful access strategies are scaled up to reach more people, as well as look at where action is not currently being taken, and where gaps remain.

“While the challenges are complex, there is now real momentum towards overcoming those challenges and pursuing opportunities to sustainably expand access to insulin products in LMICs. The public sector can adopt National Diabetes targets in line with international agreements like the World Health Assembly resolutions and take steps to meet these targets, by improving access to screening at the primary health care level, diagnosed properly and more people come for treatment.”

“A lot of these efforts can also be scaled up and specifically the government has to look at reducing the cost of payments from people while negotiating better prices, and by reimbursing the cost of insulin so it’s affordable for patients,” Iyer further said.