A study attempts to find out how India has made expensive diabetes drugs affordable

The study noted that of the 589 million adults worldwide with diabetes, 80% live in low- and middle-income countries. Representative image used. | Photo credit: Getty Images/iStockphoto

A study by diabetologists in Chennai tried to find out how India managed to reduce the prices of new and expensive diabetes drugs and what lessons this could hold for other low- and middle-income countries (LMICs). The study “Making modern diabetes drugs affordable and accessible: lessons from India for other countries” was led by V. Mohan, Chairman Diabetes Specialties Centre, Dr. Mohana, Chennai, and was published in the journal Diabetes Care.

What did the study find?

The study noted that of the 589 million adults worldwide with diabetes, 80% live in low- and middle-income countries. Modern diabetes therapies such as GLP-1 receptor agonists as well as SGLT2i (sodium-glucose cotransporter 2 inhibitors) improve cardiovascular and renal outcomes, while analog insulins help reduce the risk of hypoglycemia. However, affordability remains a barrier: diabetes requires lifelong care and management of complications.

India’s ability to keep drug prices low is closely linked to its role as a major pharmaceutical exporter, the paper said, noting a strategic legislative history of maintaining critical safeguards to prevent “patent evergreening” and allow generic drug production. It also found that the country is increasingly focusing on strengthening domestic production capacity. There are concerns about global trade policies affecting the prices and availability of raw materials. A government incentive scheme was introduced to encourage domestic production of raw materials, and from 2025 the production of 26 molecules that were previously imported was started.

The article notes that metformin and sulfonylureas continue to be the mainstay of treatment for type 2 diabetes in India – both are included in the National List of Essential Medicines (NLEM). While DPP-4 (dipeptidyl peptidase 4), SGLT2i, and GLP-1 RA inhibitors have all been introduced, they are not currently in NLEM. Initial uptake of these drugs was limited by cost. After the competitive entry of many domestic manufacturers, the price of semaglutide, for example in India, has now come down considerably and there has been a huge increase in sales; however, absolute monthly costs remain high relative to household incomes in India and, crucially, are not covered by insurance, as is largely the case in the US.

The rapid availability of generic and biosimilar drugs, deliberate regulatory and distribution strategies such as the government’s Jan Aushadi Kendras, and market competition have enabled affordable drugs in India, the paper pointed out.

What does it suggest for other LMICs?

Building local manufacturing capacity as a strategic investment in public health, balanced patent management that supports easier access to newer molecules, predictable and structured price regulation, good distribution networks at reasonable retail prices, and aligning pharmaceutical policy with health funding and continuous monitoring of drug quality, prices, prescribing patterns, and patient access can all help improve access to affordable drugs. These basic principles could also apply to high-income countries facing drug prices, the paper said.

Challenges Ahead

Issues that persist include urban-rural disparities in drug distribution and availability; strict regulations that potentially affect the chances of drug innovation; quality differences between generics and difficulties in complying with strict pharmacovigilance; as well as limited formal evaluation of government programs to determine their long-term impact on clinical outcomes.

Published – 19 Sep 2026 21:53 IST