Access Index: GLP-1s lead diabetes R&D as access lags

The Access to Medicine Foundation on November 10, 2026, released the tenth edition of its Access to Medicine Index, a ranking it publishes every two years of 20 large innovative pharmaceutical companies. The foundation’s report page says the companies were scored on 29 metrics in three areas — governance of access, research and development, and product delivery — for products and projects aimed at 84 diseases, conditions and pathogens in 113 low- and middle-income countries. The analysis covers June 1, 2024, through May 31, 2026.

The report’s diabetes section is the sharpest hook for a peptide and incretin audience: GLP-1-style projects now make up most of the diabetes pipeline the Index reviewed, while access plans for late-stage candidates are often narrow, and insulin supply remains a stated concern.

The ranking

Novartis is first overall, as it was in the previous edition, with GSK close behind. AstraZeneca is third, up from fifth in 2024. Sanofi is fourth. Boehringer Ingelheim and Roche are tied for sixth. Novo Nordisk is 11th, and Eli Lilly and Company is 18th. Those ranks are the Index’s overall scores, not a diabetes-only table.

A pipeline heavy on incretins

Citing the International Diabetes Federation, the Index says diabetes affects an estimated 589 million adults worldwide, 81% of whom live in low- and middle-income countries, and that 95% of projected growth through 2050 is expected in those countries.

The diabetes research pipeline, the report says, contains 25 projects across six companies — AstraZeneca, Eli Lilly and Company, Gilead, Novo Nordisk, Roche and Sanofi — “with Lilly and Novo Nordisk covering approximately two-thirds.” The report says innovation is concentrated in incretin and other metabolic-hormone approaches for type 2 diabetes, which account for 18 of 25 projects (72%), many of them involving GLP-1-based mechanisms. Ten of the 25 projects (40%) target type 1 diabetes. Those shares overlap within the same total of 25. Sanofi, the report says, is the only company with an active diabetes pipeline that does not have a GLP-1 candidate, and is focused solely on type 1 diabetes.

Among late-stage diabetes projects, 10 of 19 (53%) had an access plan. Of those 10 plans, 7 focused only on preparing for registration, in an average of four countries. Only 20% (2 of 10) of the plans included equitable pricing measures, the report says, and it describes the geographic reach as remaining narrow and covering mostly emerging markets.

The Index also describes company tactics for newer products. It says Lilly launched Mounjaro (tirzepatide) in India in March 2025 and, in October 2025, partnered with Cipla to expand distribution through a second-brand strategy. Novo Nordisk, it says, is also using second-brand partnerships for semaglutide, including through Extensior, a second brand of Ozempic introduced in Brazil, India and South Africa. The report added that Novo had expanded registration of Ozempic/Extensior from 26 to 56 countries since the previous Index and provided evidence of supply in 26 of those countries.

Insulin, and what companies said — or didn’t

Access problems are not limited to new drugs, the Index says. Lilly, Novo Nordisk and Sanofi collectively account for more than 90% of the global insulin market, the Index says. The report also says some companies are slimming down their insulin portfolios and scaling back production of older products and formulations, which could further limit the range of insulin products available, particularly in low- and middle-income countries.

Jayasree K. Iyer, the foundation’s chief executive, spoke to the Guardian, which quoted her as saying, “A lot of the GLP-1 drugs are just starting to enter these LMIC markets for obesity,” and, “You have a lot of attention on GLP-1s, but a lot of it is directed towards the obesity market, and that’s not going to help people with type 1 diabetes who after 105 years of insulin development still do not have access to the drug.” She also told the Guardian there is a risk that any of Sanofi, Lilly or Novo Nordisk “could leave the insulin market,” and that this “will be disastrous for supply to insulin” for people with type 1 diabetes and insulin-dependent type 2 diabetes. Those remarks are from the Guardian’s interview, not from the Index text.

The Guardian reported that Novo Nordisk “has announced plans to phase out some of its older diabetes products, including insulin pens.” Amino Wire has not independently confirmed a global pens withdrawal. The European Medicines Agency, in a page last updated May 27, 2026, said Novo Nordisk has decided to stop marketing specified insulin presentations — including certain presentations of Actrapid, Fiasp, Insulatard, Protaphane, Mixtard, Actraphane, NovoMix 50 and Levemir — in EU and EEA countries where they were marketed, “due to commercial reasons,” and that “discontinuation will take effect before the end of 2026.” EMA said the decision “is not related to a quality defect or safety issue,” and that the listed presentations were not sold in every member state.

What is not known

• How far the 10 late-stage access plans will go in practice. The Index itself says that, without clearer price and volume data, the reach of GLP-1 access efforts “remain[s] unclear.”
• Whether any of the three large insulin makers will exit the insulin market. Iyer’s warning, as reported by the Guardian, is a risk statement, not a company announcement of withdrawal.
• The full commercial scope of Novo Nordisk’s older-product changes outside the presentations EMA listed for Europe. The Guardian’s “insulin pens” wording is broader than EMA’s list of specified presentations.
• Patient-level impact in the 113 countries in scope. The report repeatedly notes limited evidence of how affordability commitments translate into volumes and prices paid.

This story summarizes a nonprofit ranking and related reporting. It is not medical advice, and it is not an endorsement of any company’s products or access programs.