ISSN 1662-4009 (online)

ESPE Yearbook of Paediatric Endocrinology (2022) 19 13.5 | DOI: 10.1530/ey.19.13.5

Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy and Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China


yufang@mail.xjtu.edu.cn Front Pharmacol 2022 13:820621. doi: 10.3389/fphar.2022.820621

Brief Summary: This national cross-sectional survey in Pakistan found poor availability of insulin in the public sector, even for brands manufactured by domestic companies.

Access to insulin remains a major issue worldwide in low- and middle-income countries (LMICs). This survey identifies many of the reasons that prevent access and provides directions for action. First, Pakistan is home to several national biosimilar human insulin manufacturers, including Getz Pharma. The cost of this biosimilar insulin is 20–30% lower than the cost of the originator brand. However, > 90% of the products found in the public sector were manufactured by multinational companies (Eli Lilly, Novo Nordisk and Sanofi), a finding that the authors attribute to marketing and promotional practices. This is an important observation at a time when WHO proposes prequalification of human insulins to facilitate the presence of smaller companies on a larger number of markets. Second, even though the cost of manufacturing human insulin and insulin analogues (recently included in the WHO List of Essential Medicines) is very similar, the retail cost of insulin analogues is 3–4 times higher. One reason may be that Pakistan does not produce biosimilar insulin analogues. Finally, while human insulin is free if obtained in the public sector, it is rarely available, meaning that patients and families have to buy it from the private sector, where it is often unaffordable. Overall, this suggests that policy makers have a major role to play in promoting access to insulin in Pakistan, similar to other LMICs.

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