Most people in lower-income countries cannot access GLP-1 drugs where available
Novo Nordisk has announced plans to phase out some of its older diabetes products, including insulin pens, according to The Guardian’s coverage of an Access to Medicine Foundation biennial report. The foundation found that most diabetes medicines under development focused on type 2 diabetes, with only 10 of 25 targeting type 1 diabetes.
Diabetes affects an estimated 589 million adults globally, 81% of whom live in low- and middle-income countries (LMICs) such as Pakistan, Egypt and Jordan. The report said many people with type 1 diabetes still cannot obtain basic insulin after 105 years of insulin development. It said GLP-1 medicines are not registered in many lower-income countries and, even where they are available, high prices and companies’ lack of equitable pricing measures leave them out of reach for most people in those places.
The foundation report said pharmaceutical firms can charge far higher prices for GLP-1 drugs including Mounjaro, Wegovy and Ozempic than for diabetes treatments such as insulin. It also said companies can earn greater profit margins on weight-loss injections and pills than on medication such as insulin.
The foundation report said GLP-1 blockbuster medications such as Novo Nordisk’s Ozempic and Eli Lilly’s Mounjaro have revolutionised obesity and diabetes treatment, but company attention has focused more on weight loss. The drugs were first developed to manage type 2 diabetes by regulating blood sugar, slowing digestion and reducing appetite. Their growing use for obesity opened a large, lucrative market, and their popularity has continued to expand since Wegovy launched in 2021. Millions of people in the US and other wealthy countries take GLP-1 medications.
“A lot of the GLP-1 drugs are just starting to enter these LMIC markets for obesity,” said Jay Iyer, the foundation’s chief executive. He added: “You have a lot of attention on GLP-1s, but a lot of it is directed towards the obesity market, and that’s not going to help people with type 1 diabetes who after 105 years of insulin development still do not have access to the drug.”
The foundation warned that pharmaceutical companies’ expanding focus on GLP-1 weight-loss medicines could divert attention from diabetes treatments such as insulin. Iyer said there was a risk that Sanofi, Eli Lilly or Novo Nordisk could leave the insulin market. He said that would be disastrous for insulin supply, especially for people living with type 1 diabetes and insulin-dependent type 2 diabetes.
The Netherlands-based nonprofit is part-funded by the UK and Dutch governments. Switzerland’s Novartis returned to the top of its global health equity ranking after displacing the UK’s GSK from the top spot in the previous ranking, while fellow British drugmaker AstraZeneca moved up to third. AstraZeneca had access plans for almost all its drugs in late-stage development, and nearly two-thirds of cancer drugs were covered by measures to make them available in poorer countries.
Iyer said the access to medicines index showed progress over the past 20 years. He said access was now considered part of corporate strategy at some companies and was sometimes included in executive bonus targets.
The report described two uneven access pathways: GLP-1 medicines were beginning to enter LMIC obesity markets but remained out of reach for most people where available, while basic insulin remained unavailable to many people with diabetes. Iyer’s warning was that higher margins on weight-loss drugs could draw manufacturers away from insulin, particularly for people with type 1 diabetes and insulin-dependent type 2 diabetes.