Growing investment in diabetes drug research is yet to translate into equitable access to treatment, with millions of patients in low- and middle-income countries continuing to face barriers to obtaining essential medicines, a new global pharmaceutical industry assessment has revealed.
The 2026 Access to Medicine Index by the Access to Medicine Foundation identifies a growing pipeline of diabetes treatments, particularly glucagon-like peptide-1 (GLP-1) medicines, but warns that access to newer therapies remains limited in countries with constrained healthcare resources.
The report identifies 25 diabetes research and development projects across six pharmaceutical companies, with innovation largely concentrated on GLP-1 medicines, which have attracted increasing attention in the treatment of diabetes.
However, the growing investment in newer treatments contrasts with persistent challenges in accessing insulin, a long-established and essential medicine for managing diabetes.
According to the Index, pharmaceutical companies Lilly, Novo Nordisk and Sanofi have undertaken initiatives aimed at expanding insulin access, but significant gaps remain, particularly in lower-income countries.
The Foundation says improving affordable and reliable access to insulin should remain a priority for pharmaceutical companies and other global health stakeholders, even as investment in newer therapies and technologies expands.
It warns that without deliberate efforts to address affordability and distribution challenges, advances in diabetes treatment could deepen existing inequalities between patients in wealthier and poorer countries.
The report calls for stronger medicine delivery systems, partnerships and measurable commitments from pharmaceutical companies to ensure that essential treatments reach underserved populations.
Beyond diabetes, the assessment identifies wider challenges in translating pharmaceutical innovation into accessible healthcare products across low- and middle-income countries.
Although pharmaceutical companies are increasingly considering access to medicines earlier in the development process, the scope of their plans remains inconsistent.
Access strategies currently cover 69 per cent of late-stage pharmaceutical pipeline candidates, representing more than three times the proportion recorded in 2018.
However, the Foundation notes that 43 per cent of access plans for non-communicable disease products focus exclusively on regulatory registration without sufficiently addressing other barriers, including affordability, availability and reliable supply.
The findings come as the pharmaceutical industry continues to expand research into diseases affecting populations across different income settings, with cancer products accounting for approximately half of all clinical development candidates.
While access plans cover 65 per cent of oncology pipeline candidates, strategies have been identified for 74 per cent of assessed cancer products in lower-middle-income countries and only 19 per cent in low-income countries.
The Index also highlights efforts by pharmaceutical companies to establish inclusive business models targeting underserved populations.
Six companies currently operate multi-country inclusive business models, up from five in 2024, collectively covering all 113 low- and middle-income countries assessed by the report.
Despite increased patient reach reported by most companies, the Foundation says inadequate product-level reporting makes it difficult to establish the actual number of beneficiaries and the effectiveness of the initiatives.
Access to Medicine Foundation Chief Executive Officer Jayasree K. Iyer said two decades of monitoring pharmaceutical industry performance had helped identify approaches that could address persistent gaps in access.
“Twenty years of progress have put us in a stronger position than ever to tackle persistent gaps in access. The Index has shown what works, companies have more tools at their disposal and access is increasingly being considered earlier,” she said.
Iyer called on pharmaceutical companies to build on the progress by extending access initiatives to more patients in underserved communities.
Foundation Director of Research Claudia Martínez said the industry was recording important developments through product approvals, research innovations, licensing agreements and more sustainable approaches to reaching patients.
However, she observed that such efforts remained concentrated among a limited number of companies, products and diseases.
“The challenge now is to take what works further and faster, and see these approaches adopted much more widely across the industry,” Martínez said.
In the overall assessment, Novartis retained the leading position for the second time, followed by GSK, with both companies ranking highest across Governance of Access, Research and Development, and Product Delivery.
AstraZeneca ranked third, Sanofi fourth, Bayer fifth, while Boehringer Ingelheim and Roche tied in sixth place. Pfizer came eighth.
The 2026 Index marks 20 years of assessing pharmaceutical companies’ efforts to improve access to medicines, with this year’s analysis covering the period between June 1, 2024 and May 31, 2026.
The Foundation says pharmaceutical innovation must be accompanied by sustainable access strategies, stronger local partnerships and transparent reporting to ensure that new and existing treatments reach patients regardless of their economic circumstances.
