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Institute Report
Understanding Insulin Market Dynamics in Low and Middle Income Countries
Producers, Supply and Cost
Aug 26, 2021
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The rising rate of diabetes globally, particularly in low- and middle-income countries (“LMICs”), represents a significant health and economic burden for all health system stakeholders, particularly people living with diabetes who need improved access to quality diabetes care. The development of a robust competitive marketplace for insulin (as well as associated products) is seen by many stakeholders as a critical requirement for improving patients’ affordable access to quality diabetes care. And yet, little is known about the insulin market dynamics in LMICs.

This report looks at the competitive landscape for insulin manufacturing in the 32 low- and middle-income countries where IQVIA audited data exist. As in the rest of the world, the three largest companies in this area (Eli Lilly, Novo Nordisk and Sanofi) account for the majority of insulin manufacturing. This report looks at the volume of insulins produced by these companies and others, and the cost to purchasers of those medicines. When other companies beyond these three hold more significant shares of the market, they may offer their insulins at lower costs. This report assesses where competition is effectively present and if there is an expected correlation to costs.

Key Messages

Insulin producers/suppliers
  • The majority of global insulin volume is produced by the three largest insulin makers globally: Eli Lilly, Novo Nordisk and Sanofi.
  • There is a diverse mix of other insulin manufacturers in the 32 LMICs (low- and middle-income countries) studied, including large biosimilar manufacturers and other manufacturers (often operating in multiple countries) and many different distribution companies marketing insulin in LMICs.
  • Across the 32 markets studied, the insulin supply situation is mixed: in 13 countries, companies other than the three largest have 31% of volume, while in the other 19 LMICs the three largest have significant share (>95%).
  • The three largest companies’ share of human insulin volume is low in some large population countries: <20% in Philippines and Mexico, <40% in Malaysia and Russia), <60% in China and Vietnam, and <70% in India and Thailand.
Insulin prices
  • There is no correlation between the three largest companies’ market share and the average insulin cost per day.
  • Insulin cost per day (at ex-manufacturer prices) is low across the 32 LMICs compared to developed markets, but has wide variations, with insulin analogs costing $0.78–1.73/day and human insulins costing $0.20–0.63/day.
  • In 13 of the 32 markets where other (non-three largest) manufacturers have a significant presence, insulin costs per day average 21–33% lower for human insulin and 2–25% lower for insulin analogs than the larger companies’ costs in the same countries.
  • However, in 19 of the 32 markets where the three largest have a very strong market presence (95+% volume market share), insulin analogs and human insulin costs per day are often lower than other LMIC countries, even in the absence of significant competition from other manufacturers.

Key Findings

  • The majority of global insulin volume is produced by the three largest manufacturers: Eli Lilly, Novo Nordisk and Sanofi.
  • Across all 32 LMICs, the three largest companies produce 83% of days of therapy measured in WHO-DDD.
  • In 19 of the 32 LMICs studied, these three companies have more than 95% market share.
  • In 13 other LMICs, other smaller companies average 31% of volume (and 22% of sales), including 27% of volume in China, 28% in India and 35% in 11 other LMIC countries.
  • Human insulins account for 58% of the days of therapy for insulins across 32 LMICs and smaller companies represent 29% of human insulin volume as measured in days of therapy (WHO-DDD).
  • Insulin analogs represent 42% of the use of insulins across 32 LMICs, with 92% of the volume produced by the three largest companies and 8% via other companies producing them as biosimilars.
  • Human insulins have less complex manufacturing and lower costs than insulin analogs.
  • Insulin analogs have risen to 42% of days of therapy, up from 25% in 2010.
  • Insulin analogs averaged 15% growth over 10 years, compared to 7% growth for human insulins in the same period.
In addition to the three largest companies, the following companies market insulin in the LMICs surveyed, often in multiple countries:
  • 12 large biosimilar manufacturers: Biocon, Bioton, Gan & Lee, Geropharm, Julphar, Kalbe Pharma, Kocak, Landsteiner, Lupin, Probiomed, Sedico and Wockhardt.
  • 28 other manufacturers: ACI Limited, Aristopharma, Arterium, Ascendis, Baxter, Belmed, BJ Ganli, Denver Farma, Incepta Pharma, Koye Pharma, Kyowa Hakko Kirin, M.J. Biopharm, Medical Union, Medsyntez, Pharmevo, Popular Pharma, Sanbe, Shreya Group, Sothema, Square, Sun Pharma, Tarchomin ZF Polfa, Tianmai Biotech, Tonghua Dongbao, USV, Unilab and Zhuhai United Lab.
  • These smaller manufacturers are often not vertically integrated and instead contract with approximately 50 distribution companies that are marketing insulin across these countries.
  • In countries where the manufacturers other than the three largest have significant share of spending, there is some local manufacturing, primarily of human insulins, and to a lesser degree, insulin analog biosimilars.
  • The number of companies manufacturing insulin is higher in countries with larger market opportunities.
  • In two of the three countries where the three largest manufacturers do not have their own direct sale – Morocco and India – they support a local company that distributes their products.
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