India has emerged as a model for making expensive diabetes medications more affordable. A study led by V. Mohan of Dr. Mohan’s Diabetes Specialities Centre, published in Diabetes Care, sheds light on strategies that could benefit other low- and middle-income countries.
The study highlights that of the 589 million adults worldwide living with diabetes, a staggering 80% reside in low- and middle-income countries (LMICs). Modern diabetes treatments, including GLP-1 receptor agonists and SGLT2 inhibitors, offer significant health benefits but remain financially out of reach for many. India’s success in maintaining low drug prices is attributed to its significant role as a pharmaceutical exporter and its legislative measures that prevent 'patent evergreening', thus facilitating the production of generic drugs.
India's focus on bolstering domestic manufacturing capacity is another key factor. The government has introduced incentive schemes to promote the local production of raw materials, with 26 molecules that were previously imported now being produced domestically. This strategic move aims to mitigate the impact of global trade policies on drug prices and raw material availability.
Despite these advancements, challenges persist. The study notes that while drugs like metformin and sulfonylureas are included in India's National List of Essential Medicines (NLEM), newer drugs such as DPP-4 inhibitors, SGLT2i, and GLP-1 receptor agonists are not. Initial high prices limited their uptake, but increased competition among domestic manufacturers has led to significant price reductions. For example, the cost of semaglutide has dropped, resulting in a surge in sales, although its monthly cost remains high relative to household income and is not covered by insurance, unlike in the U. S.
India's approach to making medications affordable includes quick availability of generic and biosimilar drugs, strategic regulatory and distribution strategies like the Jan Aushadi Kendras, and fostering market competition. These efforts have made drugs more accessible, the study notes.
Challenges and Future Directions
While India's model offers valuable lessons, the study acknowledges several challenges. Urban-rural disparities affect the distribution and availability of medicines, and stringent regulations may hinder drug innovation. There are also concerns about the quality differences between generics and the challenges of maintaining strict pharmacovigilance.
Moreover, the study points out the lack of formal evaluation of government schemes to assess their long-term impact on clinical outcomes. Despite these hurdles, the principles outlined in the study could benefit high-income countries grappling with high drug prices.
To improve access to affordable medicines, the study suggests several strategies: building local manufacturing capacity as a public health investment, balancing patent governance to facilitate access to new molecules, implementing structured price regulation, and ensuring good distribution networks at reasonable retail prices. Aligning pharmaceutical policy with health financing and ongoing monitoring of medicine quality, prices, prescription patterns, and patient access are also crucial.
