A study by Chennai-based diabetologists has attempted to find out how India has managed to reduce the prices of new and expensive diabetes drugs and what lessons this could possibly hold for other low- and middle-income countries (LMIC). The study, ‘Making Modern Diabetes Medications Affordable and Accessible: Lessons from India for Other Countries’, was led by V. Mohan, chairman, Dr. Mohan’s Diabetes Specialities Centre, Chennai, and was published in the journal Diabetes Care.
However, affordability remains a barrier: diabetes requires lifelong care and management of complications. Initial uptake of these drugs was constrained by pricing. Following the competitive entry by multiple domestic manufacturers, the price of semaglutide, for instance in India, has dropped considerably now, and there has been a huge increase in sales; however, absolute monthly costs remain high relative to the household income in India, and, crucially, these are not covered by insurance, as they are, to a great extent, in the U.S. Building local manufacturing capacity as a strategic public health investment, balancing patent governance that encourages easier access to newer molecules, predictable and structured price regulation, good distribution networks at reasonable retail prices and aligning pharmaceutical policy with health financing and ongoing monitoring of medicine quality, prices, prescription patterns and patient access can all help with improving access to affordable medicines, the paper noted. Challenges that remain include urban-rural disparities in distribution and availability of medicines; tight regulations potentially affecting chances of drug innovation; differences in quality between generics and difficulties in maintaining strict pharmacovigilance; as well as limited formal evaluation of government schemes to look at their long-term impact on clinical outcomes.
Of the 589 million adults in the world with diabetes, 80% live in LMICs, the study noted. Modern diabetes therapies such as GLP-1 receptor agonists as well as SGLT2i (sodium-glucose cotransporter 2 inhibitors) improve cardiovascular and renal outcomes, while analogue insulins help reduce the risk of hypoglycaemia. The paper notes that metformin and sulfonylureas continue to form the foundation of type 2 diabetes management in India – both are included in the National List of Essential Medicines (NLEM). SGLT2i and GLP-1 RA have all been introduced, they are not currently in the NLEM While DPP-4 (dipeptidyl peptidase 4) inhibitors.
These core principles could also apply to high-income countries facing drug prices, the paper said.
