Making Modern Diabetes Medications Affordable and Accessible: Lessons From India for Other Countries

Diabetes affects 589 million adults globally, 80% of whom live in low- and middle-income countries (LMICs). Although modern diabetes therapies such as sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) improve cardiovascular and renal outcomes and analog insulins help reduce risk of hypoglycemia, affordability remains a barrier to equitable access to these agents. This article analyzes how India has reduced the costs of modern diabetes therapies and improved affordability, pricing trends, regulatory frameworks, pharmaceutical manufacturing policies, and public distribution initiatives in India. India has achieved approximately 60%-90% price reductions for SGLT2i and GLP-1 RA following patent expiry, driven by strong generic competition, structured price regulation, and governmental support, leading to much greater access to these agents. Costs of insulin biosimilars of glargine are also much lower in India, making them more affordable. Cross-national price comparisons show 15- to 65-fold differences between Indian generic prices and U.S. list prices for selected agents. On the policy front, government initiatives like the Ayushman Bharat have considerably helped to increase accessibility for the poor and vulnerable sections of the society. Despite these advances, challenges remain, particularly in rural areas where modern therapies may still be unaffordable or unavailable. Moreover, due to multiple manufacturers providing generics, there could be differences in quality and pharmacokinetics, even between the branded generics. However, India's experience demonstrates that affordable access to modern diabetes medicines is achievable through coordinated pharmaceutical policy, regulatory efficiency, and enhanced manufacturing capacity, offering lessons for LMICs and high-income countries facing high drug costs.