New MSF costing study in JAMA reveals dramatic markup on prices of new diabetes medicines and insulin pens

GLP-1 drugs (e.g. Ozempic) are sold at a nearly 40,000% markup in the US, but are unavailable in low- and middle-income countries; and treating diabetes using insulin pen devices could be 30% less expensive than using vials and syringes if priced lower.

Geneva, 27 March 2024— A study published today by Doctors Without Borders/Médecins Sans Frontières (MSF) in the Journal of the American Medical Association (JAMA) Network Open, puts forward two key findings that reveal exorbitant corporate profiteering on newer diabetes medicines and insulin pen devices. If acted upon by policymakers, governments and procurers, the study could have a major impact on the affordability of diabetes treatments for people in low- and middle-income countries, and beyond.

The first key finding of the study is regarding a newer class of drug, GLP-1s, including those marketed as Ozempic and Trulicity by pharmaceutical corporations Novo Nordisk and Eli Lilly, respectively, that are used to treat people with diabetes and now routinely recommended and included in treatment guidelines in high-income countries. This drug class is neither included in the World Health Organization (WHO) diabetes treatment recommendations or its essential medicines list, nor in national treatment guidelines in low- and middle-income countries, where these drugs are virtually unavailable.

MSF’s study estimates that GLP-1s for diabetes could be sold at a profit for just US$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% markup over what the estimated generic price could be. However, Novo Nordisk and Eli Lilly are the only producers of these GLP-1s today, and their intellectual property barriers on the drugs and injection devices block any generic manufacturing that could help drive prices down. The corporations have not even announced a price for low- and middle-income countries, nor have they licensed these drugs so that generic manufacturers could make them, which would help to meet global demand and drive prices down. Even in high-income countries, the corporations are unable to meet the massive demand for these drugs – which are additionally used for weight loss – meaning many people living with diabetes cannot access them.

“These new drugs are an absolute gamechanger 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,” said Christa Cepuch, Pharmacist Coordinator at MSF’s Access Campaign. “Eli Lilly and Novo Nordisk can in no way supply the world with the amount of these medicines needed to meet global demand, so they must immediately relinquish their stranglehold and allow them to be produced by more manufacturers around the world.”

The study’s second key finding is regarding insulin pen injection devices, which are preferred by people living with diabetes over using multiple syringes each day to inject insulin out of vials, and are also safer with increased dosing accuracy – this is particularly 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, such as those where MSF often works. However, due to the high prices corporations charge for insulin pens, they are almost never available to people in low- and middle-income countries and are not often used by humanitarian agencies.

However, MSF’s study finds 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% markup. This means that when including the cost of insulin and the devices needed to inject it, insulin pens could actually be the more affordable option compared to the older and less user-friendly vials, if the corporations making them would reduce their prices. The standard of care in high-income countries, which is delivering analogue insulin in a pen device, could cost $111 per patient per year, which is 30% less than human insulin in a vial: continuing to deliver this double standard of care is unacceptable, and based on this costing study, unnecessary.

A survey MSF conducted in collaboration with T1International of over 400 people on insulin in 38 countries found that 82% preferred using insulin pens as it was easier to give the correct dose, was less painful and less stigmatizing to use in public. MSF’s experience offering insulin pens to people with diabetes in Lebanon has demonstrated an important impact on people’s quality of life and has helped people better adhere to their treatment. Insulin pen devices and long-acting insulin analogues have recently been included in the World Health Organization’s Essential Medicines List, which is used by countries to prioritise their own essential medicines lists and procurement plans.

“Our study shows that in fact it could be more affordable to use insulin pens for both human and analogue insulins instead of vials of human insulin injected with syringes, even though that has always been thought to be the most affordable option and therefore the only option offered to people in low- and middle-income countries,” said Dr. Helen Bygrave, Non-communicable Diseases Advisor. “If the cost of insulin and the devices needed to inject it are included in the calculation, the myth that insulin pens and newer insulins have to be more expensive is busted. Nobody starting insulin today in my medical practice in the UK would be expected to inject insulin with syringes. We need to see pharmaceutical corporations put people before their astronomical profits and bring their pen prices down dramatically, so that we can put an end to this global double standard in diabetes care.”




Diabetes affects 537 million people globally. It is not just a disease of high-income countries: cases are rising in low- and middle-income countries, with a projected increase of 134% in Africa by 2045. Only half of people who need insulin in the world have access to it. MSF has significantly increased the number of diabetes consultations in its medical programs: in 2022, MSF performed 205,122 diabetes-related consultations globally.

*Insulin is classified as either human or analogue, and by its onset and duration of action. Insulin analogues, while similar to human insulins in their basic structures, have been modified to change their onset and duration of action after injection, enabling greater flexibility of use for people living with diabetes.


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