Access to Insulin and Diabetes Care in the Philippines.

Millions of people from low-income and middle-income countries (LMICs) are unable to access insulin and routine diabetes care.1The Lancet Diabetes & EndocrinologyInsulin for all: a hope yet to be realised.Lancet Diabetes Endocrinol. 2021; 9: 639Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar The Philippines, a lower-middle income country in southeast Asia with almost 4 million adults with diabetes,2International Diabetes FederationIDF Western Pacific Members: The Philippines.https://idf.org/our-network/regions-members/western-pacific/members/116-the-philippines.htmlDate: May 14, 2020Date accessed: October 10, 2022Google Scholar is no stranger to this crisis. Diabetes ranks fourth among the leading causes of death in the Philippines.3Philippine Statistics AuthorityCauses of deaths in the Philippines (preliminary): January to December 2020.https://psa.gov.ph/content/causes-deaths-philippines-preliminary-january-december-2020Date: March 16, 2021Date accessed: November 11, 2022Google Scholar Filipino people face substantial barriers to health care, which preclude access to insulin and diabetes care, including inadequate health financing leading to high out-of-pocket expenditure and a fragmented referral system from primary care to specialised care units. During the COVID-19 pandemic, access to diabetes medications became an even greater problem for Filipino people because of financial constraints from the economic recession and substantial supply deficits. Addressing these barriers is instrumental to solving the problem of insulin and diabetes care access in the country. In 2009, the Philippine Department of Health launched the Insulin Medicine Access Program (InMAP), a public–private partnership to provide affordable insulin.4Department of HealthRepublic of the PhilippinesInsulin access program.https://doh.gov.ph/faqs/Insulin-Access-ProgramDate accessed: October 10, 2022Google Scholar Under InMAP, pharmaceutical companies provide insulin products through consignment with 22 hospitals across the country. However, most of these hospitals are in cities, presenting a challenge for patients living in geographically isolated and disadvantaged areas. Expanding InMAP is crucial to increase accessibility and reduce the out-of-pocket costs of insulin. The Universal Health Care Act of the Philippines, passed in 2019, created the Health Technology Assessment Council (HTAC), an advisory body mandated to recommend medicines and technologies for government funding.5Department of HealthRepublic of the PhilippinesImplementing rules and regulations of the Universal Health Care Act (Republic Act No. 11223).https://doh.gov.ph/sites/default/files/health_magazine/UHC-IRR-signed.pdfDate: 2019Date accessed: October 15, 2022Google Scholar Currently, a single insulin analogue pen is worth 3 days of minimum wage pay. To bring down these costs and leverage government negotiations, HTAC is working to include insulin analogues in the Philippine formulary. As this approach gains momentum, strengthening primary care units and referral systems is imperative to create a robust infrastructure for diabetes care delivery. We agree with the sentiment expressed in the recent Editorial1The Lancet Diabetes & EndocrinologyInsulin for all: a hope yet to be realised.Lancet Diabetes Endocrinol. 2021; 9: 639Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar in The Lancet Diabetes & Endocrinology that global collaborative action is needed to tackle the diabetes epidemic. We also support multisectoral discussions among local ministries of health, policy makers, health-care workers, patient advocates, community leaders, and pharmaceutical companies to make insulin more accessible and affordable. Furthermore, we encourage LMICs to come together and share best practice in diabetes care and prevention given limited resources. Not least, we look forward to the fulfillment of the WHO Global Diabetes Compact,6Hunt D Hemmingsen B Matzke A et al.The WHO Global Diabetes Compact: a new initiative to support people living with diabetes.Lancet Diabetes Endocrinol. 2021; 9: 325-327Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar which aims to increase treatment access, improve patient outcomes, and promote prevention of diabetes. The Compact's vision can be realised, but only through meaningful engagement, united action, and lifelong commitment among stakeholders around the world. CAJ has received honoraria for serving on the speaker's bureau for Novo Nordisk, Sanofi Aventis, Merck, Merck, Sharpe and Dohme, Servier Philippines, and Johnson and Johnson. CAJ has also received support for attending meetings and travel for conventions from Sanofi Aventis, Merck, Sharpe and Dohme, Natrapharm, Novo Nordisk and AstraZeneca. All other authors declare no competing interests. Insulin for all: a hope yet to be realisedThis year, 2021, we celebrate the centenary of the discovery of insulin—one of the greatest medical achievements of all time. Clinical use of insulin marked the dawn of an era of diabetes management, transforming the lives of people with type 1 diabetes for whom the disease had previously been a death sentence, and those with other forms of diabetes for whom it is an essential therapy. Full-Text PDF