The global insulin market remains dominated by three multi‐national companies, Eli Lilly, Novo Nordisk and Sanofi, identified in the present study as the ‘big three', with these companies controlling 99% of the market by value and 96% of the market by volume 4, 5. Patents on human insulin expired many years ago, and by the end of 2015, 11 of the most commonly sold insulin products in the USA were not protected by patents 3. Insulin was discovered in 1921 and first used in 1922. Out‐of‐pocket payments, if any, should be well within patients' capacity to pay, and protection against catastrophic expenditure should be ensured.' 1 There are large gaps in access to medicines for non‐communicable diseases worldwide 2 and insulin provides a unique lens through which to assess barriers to access to medicines. The WHO defines access to medicines as ‘the reliable and consistent availability of appropriate essential, quality medicines at health facilities, the rational prescribing and dispensing of such medicines, and ensuring that they are affordable.
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