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Despite growing pharmaceutical investment in diabetes research and new drug development, access to affordable insulin remains a major challenge in low- and middle-income countries (LMICs), including Nigeria, the 2026 Access to Medicine Index has revealed.
The report warned that the growing focus on newer diabetes treatments, particularly GLP-1 medicines, must not overshadow the persistent barriers preventing millions of people from accessing essential insulin.
The 2026 Index, released by the Access to Medicine Foundation in Amsterdam, Netherlands, found that six pharmaceutical companies have 25 diabetes research and development projects, with innovation heavily concentrated on GLP-1 medicines.
However, it noted that, despite efforts by Eli Lilly, Novo Nordisk and Sanofi to expand insulin access, significant gaps persist, particularly in lower-income countries.
The report called on pharmaceutical companies and other global health stakeholders to prioritise affordable and reliable insulin supplies, while ensuring that newer treatments do not deepen inequalities in healthcare access.
It stressed the need for stronger delivery models, partnerships and measurable commitments to expand access to diabetes medicines.
The findings come against the backdrop of growing diabetes burden in LMICs, where access to essential medicines remains a major challenge despite advances in pharmaceutical research.
The report also identified broader gaps in pharmaceutical companies’ efforts to make essential medicines accessible, despite improvements in how they integrate access considerations into product development and business operations.
According to the index, access plans now cover 69 per cent of late-stage pharmaceutical pipeline candidates, more than three times the proportion recorded in 2018.
However, progress remains uneven, particularly for some non-communicable diseases, with 43 per cent of access plans for such products focusing only on registration rather than addressing wider barriers to affordability, availability and supply.
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On cancer, the report found that the disease accounts for about half of pharmaceutical clinical development candidates, while access plans cover 65 per cent of oncology pipeline products.
It identified growing efforts to extend cancer treatment access beyond high-income countries, although strategies were identified for only 19 per cent of assessed cancer products in low-income countries.
The index also found that six pharmaceutical companies now operate inclusive business models targeting underserved populations across all 113 low- and middle-income countries covered by the assessment.
However, it warned that inadequate product- and country-level reporting makes it difficult to determine how many patients are benefiting from these initiatives.
Marking 20 years of tracking pharmaceutical companies’ contributions to global health equity, the 2026 Index said access to medicine has become more integrated into companies’ operations, but progress remains insufficient to meet the needs of vulnerable populations.
Chief Executive Officer, Access to Medicine Foundation, Jayasree Iyer, said the industry had made significant progress but needed to extend its reach.
She said companies now had more tools to address access barriers and were increasingly considering access earlier in product development, adding that the priority was to build on these gains and reach more patients.
The Index ranked Novartis first for the second time, followed by GSK, while AstraZeneca, Sanofi, Bayer, Boehringer Ingelheim, Roche and Pfizer also featured among the eight leading companies.
It assessed pharmaceutical companies’ performance between June 1, 2024 and May 31, 2026, with greater emphasis on implementation and measurable outcomes.
