Presentation (CTI)

OBJECTIVES: Insulin is vital in diabetes management. American Diabetes Association recommends initiating basal insulin therapy in patients with uncontrolled HbA1c levels after >3 months of triple combination therapy. However, various barriers to insulin access, including high prices, have been found in studies conducted in low and middle-income countries. The objective of this study was to assess the availability of cold chains and insulin products in Kalyan West (Mumbai's suburban city).
METHODS: Questionnaire-based survey was conducted at 64 retail pharmacy outlets in the west region of Kalyan. Data on the availability of Insulin products, Cold Chain facilities, and Maximum Retail Price (MRP) were collected.
RESULTS: Insulin products were available in 59% (n=38) of pharmacies. All 38 pharmacies had cold chain facilities (refrigerators) for insulin storage, and all except 5 pharmacies had an inverter facility in the case of electricity cut-off. Insulin refill was available in vials (single unit) and cartridges (single unit, pack of 3 or 5). 31 pharmacies (81%) provided discounts (mean, 10%, range 5-15%) on the MRP of Insulin. The average MRP of fast-acting insulin (100 IU. 10 ml) vials was INR 2.077 and after applying a discount of 10% (INR 1869.4). The cost per unit of insulin was lower in Insulin vials than in cartridges at 100 IU/ml based on MRP, where 1 unit of fast-acting insulin in a vial cost INR 2.077, while in cartridges INR 3.337. Availability of insulin varied by area, as pharmacies with insulin products were concentrated (81.58% or 31 pharmacies) in the Khadakpada part of the city. Most pharmacies kept the insulin products of 1-2 companies only.
CONCLUSIONS: Addressing these costs and ensuring equitable access to affordable insulin is vital for diabetes management. Per unit cost of insulin is lower in vials compared to cartridges. Thus, vials offer a more economical approach than cartridges.