SA’s competition authority has launched a probe into insulin pen manufacturers Novo Nordisk and Sanofi Aventis for possible anticompetitive practices.
The Competition Commission’s probe was launched after health activists publicly raised concerns about Novo Nordisk’s decision to stop providing human insulin pens to the health department in 2024 and offer only vials, which must be administered with a syringe. Pens are more accurate and easier to administer than injections.
An estimated 4.23-million South African adults, or 11.3% of the adult population, were living with diabetes in 2021, according to the International Diabetes Federation.
Novo Nordisk, which began providing insulin pens to the state in 2014, was the sole supplier when it informed the health department in October 2023 that it would not bid for its 2024 tender. This decision forced thousands of diabetes patients to switch to injecting insulin, according to the Health Justice Initiative (HJI).
The HJI is a nonprofit public health and law organisation, and is campaigning for wider access to insulin pens with health activists from the Treatment Action Campaign and Médecins Sans Frontières. They say insulin pens can be sold for as little as $0.94 and still be profitable.
Two other global pharmaceutical companies that make insulin — Sanofi Aventis and Eli Lilly — also chose not to bid for the health department’s tender for human insulin pens in 2024.
As a result, the state purchased a limited number of analogue insulin pens from Sanofi Aventis directly, or “off tender”. Insulin analogues are modified to adjust their speed of absorption and are more expensive than human insulin.
Sanofi’s insulin pens ranged in price from $2.24 for long-acting analogue pens to $4.26 for ultrafast acting analogue pens, according to the HJI.
There can be no room for monopolistic behaviour by big pharma when it comes to life-saving medicines and devices, who are now, for diabetes care, trying to take us back to the dark ages.
— HJI founder Fatima Hassan
Siyabulela Makunga, the Competition Commission’s spokesperson, confirmed the organisation had initiated a complaint against Novo Nordisk and Sanofi Aventis, but declined to provide further details.
The HJI said the probe would examine whether multiple device patents and proprietary designs for insulin pens and cartridges are being used to exclude competition and prevent the entry of alternative suppliers. The pens and insulin cartridges made by different manufacturers are not interchangeable.
HJI founder Fatima Hassan said the investigation was long overdue. “There can be no room for monopolistic behaviour by big pharma when it comes to life-saving medicines and devices, who are now, for diabetes care, trying to take us back to the dark ages.”
Hassan urged the government to improve its regulation of medicine licensing, access and pricing as the health department will be the sole procurer of medical products under its proposed National Health Insurance (NHI) scheme.
“We want a single medicine selection and access system, with a single fair price for all, that does not enable excessive profiteering, bullying and abuse [by pharmaceutical firms], she said. “The insulin saga shows how pernicious that power is, with private market forces [deciding] the future of our health.”
The HJI called on the commission to look into the licensing agreement between Novo Nordisk and Aspen Pharmacare, saying it might contribute to a generic monopoly on diabetes products.
Aspen announced in 2023 that it had secured an agreement with Novo Nordisk to manufacture human insulin vials at its Gqeberha plant, for distribution in Africa.
“We hope that the commission will also examine whether the recent shift in manufacturing focus towards weight-loss pens has contributed to insulin pen supply issues, potentially harming diabetes patients who must revert to using vials,” HJI said.
• This story has been amended to clarify that the Competition Commission launched its investigation in response to concerns raised publicly by health activists, and not in response to a formal complaint as previously reported. It also clarifies the prevalence of diabetes in SA.
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