OBJECTIVES: Insulin is an essential medicine (EM) for diabetics. This study evaluated insulin availability and affordability in public and private health sectors in Bengaluru (Karnataka), India.

METHODS: Using a modified WHO/HAI methodology, we collected insulin availability and price data in 10 hospital pharmacies (5 each in public and private sectors) and 30 private-sector retail pharmacies. Mean availability is reported as percentage of surveyed facilities where a given product was found. Median prices of all insulin products, adjusted to 100 IU/10 mL, were calculated. Insulin was considered unaffordable if a lowest paid unskilled worker spends >1-day’s wage to afford monthly supply.

RESULTS: Mean availability of insulin products listed on India’s 2015 EM list was 66.7% in the public sector as compared to 76.05% and 93.3%, respectively, in private-sector retail and hospital pharmacies. Among private retail pharmacies, mean availability was higher among chain (96.7%) compared to independent pharmacies (68.3%). Overall, in both sectors combined, majority of found products (67.3% i.e. 247 out of 367) were supplied by overseas companies (Novo Nordisk etc.). Most products were manufactured in India (78.1%), of which 60% were marketed by overseas companies.

In private retail pharmacies, median consumer price of human insulin cartridges (USD 12.24) and pen (USD 17.98) were 2.5 and 3.6 times the price of human insulin vials (USD 4.97), respectively. Analogue insulin products [median price range: USD 17.89-33.20 depending on delivery form] were twice as expensive as human insulin. A lowest paid unskilled worker in Bengaluru would pay 1.4 to 9.3 days’ wages to purchase monthly supply depending on insulin type and sector.

CONCLUSIONS: Compared to WHO target of 80% availability, insulin availability is limited in Bengaluru’s public sector. Insulin remains unaffordable to low-income individuals in both private and public sectors. While overseas companies dominate Bengaluru’s insulin market, increasing market competition from Indian companies may improve access.