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The three companies that dominate the global market for insulin have launched various programs to expand the reach of their medicines in dozens of low and middle-income countries — but their efforts remain patchy and equitable access consequently remains out of reach, according to a new analysis.

Too often, the manufacturers — Eli Lilly, Sanofi, and Novo Nordisk — do not understand the extent to which the public and private sectors in many poorer countries can afford insulin, the report found. But a more troubling issue is that the companies failed to register their products — both the older human form of insulin and newer analogue varieties — with regulators in many countries.

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