The global insulin supply could suffer as drugmakers chase GLP-1 weight-loss drugs, the 2026 Access to Medicine Index warned on Tuesday. Eli Lilly, Novo Nordisk and Sanofi sell more than 90% of the world’s insulin. The report says some of them are trimming older insulin products while their pipelines fill with GLP-1 medicines.
The warning matters most for people with type 1 diabetes, who depend on insulin every day. Most people with diabetes live in low- and middle-income countries. There, the report says, insulin “remains out of reach for many people” a century after its discovery.
In the US the picture is different, but not untouched: three Lilly insulin pens are on their way out.
What the 2026 Index found in the diabetes pipeline
The Access to Medicine Foundation is a Dutch non-profit. Its Index, first published in 2008, ranks 20 of the largest drugmakers on access in poorer countries. Its funders include the Gates Foundation and the UK and Dutch governments. This year’s full report includes a four-page spotlight on diabetes.
It counts 25 diabetes projects in development across six companies, and Lilly and Novo Nordisk hold about two-thirds of them. Eighteen are hormone-based drugs for type 2 diabetes. Many use GLP-1, the mechanism behind Ozempic and Mounjaro.
Only 10 target type 1 diabetes. Sanofi is the only company with an active diabetes pipeline that has no GLP-1 candidate.
The report says 589 million adults have diabetes, and 81% of them live in low- and middle-income countries.
Of 19 late-stage projects, 10 have an access plan. Seven of those only prepare for registration, and just two include equitable pricing.
Why the foundation’s CEO says a big maker could walk away
Jay Iyer, the foundation’s chief executive, put the risk more bluntly in an interview with The Guardian (syndicated on AOL). “There is a risk that any of the three – Sanofi, [Eli] Lilly or Novo [Nordisk] – could leave the insulin market,” Iyer said. That, Iyer added, would be “disastrous” for insulin supply, especially for people with type 1 diabetes.
The report itself does not predict an exit. It says “some companies are slimming down their insulin portfolios and scaling back production of older products and formulations.” That could narrow the insulin choices in poorer countries. The commercial pull is plain, the Guardian reported: GLP-1 drugs earn far higher prices and margins than insulin.
Novo Nordisk gets the most specific scrutiny. Its report card says the company “began phasing out human insulin pen production amid manufacturing capacity constraints.” It also notes Novo’s September 2025 restructuring. That shifted resources toward diabetes and obesity and cut jobs. Novo told the Guardian it would “carefully review the index’s findings,” including chances to widen access to analogue insulins.
The overall 2026 ranking puts Sanofi fourth of 20, Novo Nordisk 11th and Lilly 18th. Sanofi is also building. On October 19 it broke ground on a new insulin plant in Frankfurt, due for full production in 2032. Sanofi CEO Belén Garijo said the company’s “commitment to them is for the long term,” referring to the millions who use insulin daily.
GLP-1s are only starting to reach poorer countries
The report finds GLP-1 access in lower-income countries so far “selective, market-specific and largely commercially oriented.” Since the last Index, Novo has registered Ozempic and its second brand, Extensior, in 56 countries, up from 26. It showed evidence of actual supply in 26 of them. Lilly launched Mounjaro in India in March 2025 and later partnered with Cipla to reach beyond the major cities.
Cheaper generics are coming as semaglutide patents expire. Sun Pharma won approval for a generic in South Africa in July 2026, the report notes. Still, the authors expect generics to target higher-income markets first.
None of this helps people with type 1 diabetes, for whom insulin “remains essential,” in the report’s words. Iyer told the Guardian that much of the GLP-1 attention “is directed towards the obesity market.” The report’s data point the same way. Wider GLP-1 access and the insulin gap are separate problems, and fixing one won’t close the other.
No US insulin shortage, but three Lilly pens are ending
US patients face a different situation. We checked the FDA’s drug shortage database on November 11. No insulin product is on its list of current shortages. Insulin shows up only in the discontinuations tab, and all three entries are from Lilly.
On September 1, Lilly reported three products it will stop making. They are the Insulin Lispro Junior KwikPen, a Humalog Mix 75/25 pen and Rezvoglar, an insulin glargine. The FDA’s discontinuation notice calls each “a business decision” and says distribution is projected to end in June 2027.
This has happened before. Novo Nordisk ended Levemir, a long-acting insulin, in the US on December 31, 2024. The company cited manufacturing constraints, lost insurance coverage and other options on the market, BioSpace reported at the time.
Our own reporting on estrogen patches shows the FDA list can lag what patients see at the pharmacy. So a clean list is not a guarantee.
What to do if your insulin is discontinued or costs too much
If your pen is on the list, ask your prescriber about a switch well before your supply runs out. Lilly’s notice tells patients and prescribers with questions to call the Lilly Answers Center at 1-800-545-5979.
The cost rules depend on your coverage:
- Medicare: a month’s supply of each covered insulin costs $35 at most, with no deductible, Medicare says.
- Lilly: its Insulin Value Program charges $35 a month for any Lilly insulin. It covers people with commercial insurance or none, not federal programs.
- Novo Nordisk: MyInsulinRx costs as little as $35 a month with commercial insurance or none, NovoCare says. Uninsured and Medicare patients may qualify for free medicine through its patient assistance program.
- Sanofi: since January 1, 2026, any Sanofi insulin costs $35 a month for anyone with a prescription, Medicare included. The company announced the change in September 2025.
Taking a GLP-1 drug too? Our explainer covers the FDA’s new Ozempic vision-loss warning, added on Monday.
The foundation will brief company staff on its findings in a webinar on January 26, 2027. For US patients the next fixed date is June 2027, when Lilly expects its three discontinued pens to leave distribution.
