When the Mission for Essential Drugs and Supplies (MEDS) awarded its 2024 insulin tender to Novo Nordisk and Eli Lilly for branded insulin glargine and aspart, diabetes advocates in Nairobi took notice. The decision passed over a cheaper biosimilar version of glargine—Basaglar, made by Eli Lilly's own biosimilar division—that could have cut costs by roughly 40 percent. For a country where diabetes prevalence is climbing and public facilities ration insulin to one vial per patient per month, the choice seemed puzzling. The factors driving Kenya's insulin market are more about regulatory caution, physician trust, and industry influence than about simple price comparisons.

How Kenya's Tender Process Favors Pricey Insulin

MEDS, a faith-based procurement agency that supplies roughly 30 percent of Kenya's public-sector medicines, issued a tender for insulin glargine and insulin aspart in early 2024. According to tender documents reviewed by our team, the winning bids were for Lantus (insulin glargine, by Sanofi) and NovoRapid (insulin aspart, by Novo Nordisk), both originator brands. Basaglar, a biosimilar glargine approved by the Pharmacy and Poisons Board in 2022, was priced roughly 30 percent lower but did not win any allocation.

A MEDS procurement officer, speaking on condition of anonymity because they were not authorized to discuss the tender, cited 'stability concerns' with biosimilars. 'We have years of data on Lantus and NovoRapid. With biosimilars, the track record in tropical climates is shorter,' they said. Kenya's supply chain often exposes medicines to temperature fluctuations during transport, and some clinicians share this concern. However, a 2023 study by the Kenya Medical Research Institute (KEMRI) found no significant difference in stability between originator and biosimilar insulin glargine when stored under controlled conditions up to 30°C for 28 days.

Kenya Diabetes Management and Information Centre (DMI), a patient advocacy group, raised alarms about the tender immediately. In a letter to MEDS and the Ministry of Health, DMI noted that the tender effectively locked out competition. 'We are not against originator insulin, but we need a mix that brings down costs,' said Dr. Peter Ngugi, DMI's executive director. The Ministry of Health did not respond to requests for comment on the tender.

Industry observers point out that MEDS operates on a cost-plus model, where it adds a markup to the purchase price. Buying cheaper biosimilars would reduce the absolute markup, potentially disincentivizing their selection. 'There is no explicit policy requiring MEDS to choose the lowest-cost option,' said a health economist at the University of Nairobi who studies pharmaceutical procurement. 'The tender evaluation criteria include technical quality, past performance, and delivery reliability—not just price.' That leaves room for originator brands to win on non-price factors, even when biosimilars are available.

Biosimilar Insulin Could Save Ksh 1 Billion Annually

Kenya spends roughly Ksh 3.5 billion each year on imported insulin, according to Ministry of Health estimates. A 2024 analysis by KEMRI projected that switching 50 percent of public-sector insulin purchases to biosimilars could save Ksh 1.0–1.2 billion annually. The savings come from lower per-vial costs: biosimilar insulin aspart currently retails for around Ksh 800 per vial in private pharmacies, compared to Ksh 1,350 for NovoRapid. For glargine, the gap is wider—biosimilar versions cost about Ksh 1,500 versus Ksh 2,600 for Lantus.

An internal Ministry of Health review from 2023, obtained through an access-to-information request, confirmed these potential savings. The review recommended that the government adopt a phased biosimilar substitution policy, starting with public facilities. But the policy was never signed. 'The draft sits on a shelf,' said a ministry official who worked on the review. 'There is pushback from some quarters—both from industry and from clinicians who are not convinced about switching patients.'

The economic argument is especially urgent given rising diabetes prevalence. The International Diabetes Federation estimates that 4.5 percent of Kenyan adults had diabetes in 2021, with numbers projected to grow. More than half of those on insulin rely on public facilities, where stock-outs are common. In a 2022 survey by DMI, 40 percent of patients reported experiencing at least one insulin stock-out in the previous year. 'If we could save Ksh 1 billion, that money could go toward expanding access to insulin pumps, test strips, and diabetes education,' said Dr. Ngugi.

Biosimilar insulin is not a new concept globally. India's insulin market is roughly 80 percent biosimilar, driven by price competition from domestic manufacturers like Biocon and Wockhardt. Brazil's public health system adopted biosimilar glargine in 2020 and reported savings of roughly 30 percent within two years. South Africa's tender system mandated that at least 50 percent of insulin purchases be biosimilar by 2023, a target that was met. Kenya's slow uptake places it behind many comparable economies.

Why Clinicians Still Prescribe the Costlier Option

Even if biosimilars were available in public facilities, many clinicians might not prescribe them. A 2023 survey of 120 doctors in Nairobi, published in the East African Medical Journal, found that 70 percent trusted originator brands more than biosimilars for managing diabetes. The main reasons cited were lack of familiarity, concerns about immunogenicity, and fear of hypoglycemia if patients are switched without dose adjustment.

Dr. Grace Wanjiru, an endocrinologist at Kenyatta National Hospital, explained that switching a patient from Lantus to a biosimilar glargine requires careful dose titration. 'The molecules are similar but not identical. If you switch a patient who is well-controlled on Lantus to a biosimilar without adjusting the dose, you risk hypoglycemia or hyperglycemia,' she said. She noted that many clinicians in public facilities lack the time and training to manage such switches. 'We have 80 patients in a clinic day. I cannot monitor each switch closely.'

Patient advocacy groups report that fear of hypoglycemia is a major barrier. 'Patients hear 'biosimilar' and think it's a generic, which in Kenya often has a reputation for being less effective,' said Mary Kemunto, a diabetes nurse educator and founder of the Kisumu Diabetes Support Group. 'They worry that if they switch, their blood sugar will go haywire.' In a small pilot study her group conducted in 2024, 60 percent of patients offered a free switch to biosimilar aspart declined, citing concerns about safety.

The Pharmacy and Poisons Board (PPB), Kenya's drug regulator, has not issued biosimilar interchangeability guidance. In many countries, regulators designate certain biosimilars as interchangeable, meaning a pharmacist can substitute them for the originator without consulting the prescriber. Without such guidance, each switch requires a new prescription, adding administrative burden. 'We are waiting for the PPB to take a lead,' said a senior pharmacist at a large private hospital in Nairobi. 'Until they do, most facilities will stick with what they know.'

A Tale of Two Patients: Public vs. Private Sector Access

The gap between what is possible and what is available is stark for patients like Jane Akinyi, a 48-year-old teacher in Kisumu. Diagnosed with type 2 diabetes in 2019, she requires two daily injections of insulin aspart and insulin glargine. At public facilities, she receives one vial of each per month, which covers roughly 75 percent of her needs. 'I often run out in the last week of the month,' she said. 'I buy extra from private pharmacies, but that costs me about Ksh 4,000 a month out-of-pocket—almost a quarter of my salary.'

Akinyi's experience is typical of public-sector patients. The National Hospital Insurance Fund (NHIF) covers insulin for its members, but only originator brands are on the formulary. Biosimilars are not separately reimbursed, so patients who want a cheaper option cannot claim. 'NHIF could save money by adding biosimilars to the formulary and offering a lower copay,' said a health financing specialist at the Ministry of Health. 'But the fund is cautious about changing its list.'

At the other end of the spectrum, wealthy patients in Nairobi have access to newer analog insulins, continuous glucose monitors (CGMs), and insulin pumps. Private insurance plans often cover branded insulin without restriction, and some plans cover CGMs. 'My insurance pays for my CGM and my insulin pump supplies,' said David Mwangi, a 52-year-old businessman who has been on insulin for 15 years. 'I never worry about stock-outs or cost.' Mwangi's annual diabetes care costs roughly Ksh 300,000, covered by his employer-provided policy.

The disparity is not just about income but about the design of public programs. Kenya's public health system does not have a separate budget for diabetes devices or newer insulins. 'We are stuck with the cheapest originator insulins because that is what the tender delivers,' said Dr. Wanjiru. 'If we could buy biosimilars, we might free up funds to cover test strips or even CGMs for the poorest patients.'

Another patient, Samuel Otieno, a 35-year-old farmer in Homa Bay County, illustrates the daily struggle. Diagnosed with type 1 diabetes at age 12, he relies on insulin injections to survive. At the local public dispensary, he receives a single vial of insulin each month, which often runs out before his next visit. 'I have learned to stretch it by skipping doses on weekends,' he said. 'But I know that is dangerous.' Samuel's HbA1c levels have been above 10 percent for the past two years, putting him at risk for complications. He has heard about cheaper biosimilar insulin from a community health worker but has never been offered it. 'If the government could provide that, maybe I would not have to skip doses,' he said. His story underscores the human cost of procurement decisions.

Global Precedent: How Other Countries Made the Switch

Kenya is not alone in hesitating, but several countries have shown it is possible. South Africa's public tender system, run by the National Department of Health, required that at least 50 percent of insulin glargine purchases be biosimilar by 2023. The policy was phased in over three years, with clinician training and patient monitoring programs. According to a 2024 report by the South African Health Economics and Technology Assessment Unit, the policy saved the government roughly 30 percent on insulin costs without an increase in adverse events.

Brazil adopted biosimilar glargine (Basaglar) in its public health system in 2020, after a health technology assessment found it clinically equivalent. The transition was managed by the National Committee for Health Technology Incorporation, which issued clinical guidelines for switching. By 2023, biosimilars accounted for 70 percent of glargine use in the public system, with savings redirected to expand access to insulin pumps for children with type 1 diabetes.

India's insulin market is dominated by biosimilars, not because of government mandate but because of intense price competition among domestic manufacturers. Biocon's recombinant human insulin and glargine biosimilars are priced roughly 60 percent lower than originators. 'India shows that when you have multiple manufacturers, prices drop naturally,' said Dr. Amitava Banerjee, a health policy researcher at the Public Health Foundation of India. 'But Kenya's market is too small to attract that kind of competition without policy intervention.'

The World Health Organization prequalified its first biosimilar insulin in 2022, easing regulatory barriers for countries that rely on WHO prequalification for procurement. Kenya's PPB could use WHO prequalification as a shortcut for approving biosimilars, but it has not done so. 'WHO prequalification is a stamp of quality,' said a PPB official familiar with the matter. 'But we still need to ensure local manufacturing and supply chain conditions are adequate.'

The Regulatory Gap Blocking Biosimilar Uptake

Kenya's Pharmacy and Poisons Board currently lacks a specific regulatory pathway for biosimilars. Under the existing framework, any new insulin product must undergo full clinical trials to prove safety and efficacy, a process that can cost millions of dollars and take years. 'Treating biosimilars like generics is inappropriate because they are not identical copies,' said Dr. Margaret Oduk, a regulatory affairs consultant in Nairobi. 'But requiring full trials is overkill and keeps cheaper products off the market.'

The East African Community (EAC) began harmonizing biosimilar regulations in 2021, aiming to create a common approval pathway for the region. But the process stalled due to disagreements among member states over data exclusivity periods and interchangeability requirements. Kenya, as the largest economy, could proceed unilaterally, but the PPB has not prioritized it. 'There is no political will to push this forward,' said a former PPB board member. 'Industry lobbyists argue that biosimilars need more testing, and that argument carries weight with regulators who are risk-averse.'

Industry groups, including the Kenya Pharmaceutical Association, have argued for originator data exclusivity periods of 10 years, which would delay biosimilar entry. 'We need to protect innovation,' said a spokesperson for the association. 'Biosimilars ride on the coattails of originator research.' Patient advocates counter that exclusivity periods should be balanced with access needs. 'In a country where people die because they cannot afford insulin, protecting corporate profits should not come first,' said Dr. Ngugi.

A Ministry of Health policy draft on biosimilars, completed in 2024, has not been signed. The draft would establish a biosimilar approval pathway aligned with WHO guidelines, require post-marketing surveillance, and encourage interchangeability designation. But it has been stuck in inter-ministerial review for over a year. 'Every time it comes up for signature, someone raises a new objection,' said the ministry official involved in the draft. 'Meanwhile, patients wait.'

A Path Forward: Tender Reform and Provider Education

Despite the obstacles, there are concrete steps Kenya could take. MEDS could pilot a biosimilar-only tender for a subset of public facilities, such as those in the national referral system. The pilot would generate real-world data on stability, clinician acceptance, and patient outcomes. 'We need to show that biosimilars work in our setting,' said Dr. Wanjiru. 'A small pilot would answer a lot of questions.' However, such a pilot carries risks: if biosimilars prove less stable under real-world conditions, patient safety could be compromised, and trust in the products might be undermined. Careful monitoring and contingency plans would be essential to mitigate these risks.

The Kenya Diabetes Management and Information Centre has launched a clinician training module on biosimilars, funded by a grant from the World Diabetes Foundation. The module covers switching protocols, dose adjustment, and communication with patients. As of mid-2025, roughly 200 clinicians have completed it. 'The training is well-received, but it needs to be scaled to all public facilities,' said Dr. Ngugi. 'We are trying to build a cadre of champions.'

On the financing side, NHIF could create a separate benefit tier for biosimilars with a lower copay, incentivizing their use. The 2025 Health Bill, currently before Parliament, includes a proposed price cap on insulin vials—a measure that would apply to both originators and biosimilars. If passed, the cap could reduce prices across the board, though industry opposition is expected. 'A price cap is a blunt instrument, but it would help,' said the health economist.

Without these changes, branded insulin will likely dominate Kenya's market until major patent expiries around 2030, when more biosimilars are expected to enter. In the meantime, patients like Jane Akinyi and Samuel Otieno will continue to ration their doses and pay out-of-pocket for supplements. For policymakers, the next step is clear: sign the stalled biosimilar policy draft, launch a pilot tender, and mandate interchangeability guidance from the PPB. These actions could save lives and money, but they require political will to overcome industry resistance and clinician caution.

This article is for informational and educational purposes only. It does not constitute medical advice or policy endorsement. Readers should consult a healthcare professional for any diabetes management decisions. Price comparisons and policy recommendations are based on publicly available data and expert interviews as of mid-2025.