Dataset used for analyses.

BackgroundPakistan faces the highest global prevalence of diabetes and has recently implemented a price deregulation policy for medicines not listed on the National Essential Medicines List (NEML). Pakistan’s NEML 2023 is a direct adoption of the 23rd WHO Model EML rather than a country-specific prioritization; nonetheless, it has been used to identify medicines for exemption from price controls.MethodsThis study evaluated the effect of the price deregulation policy on insulin access in Pakistan. We surveyed 30 retail pharmacies across six regions using an adapted WHO/HAI approach. Post-deregulation data on consumer prices and availability were collected. Pre-deregulation prices were extracted from published sources. The insulin prices were standardized to 10 ml at 100 IU/ml. Difference-in-Differences (DiD) analysis was used to compare price changes between non-NEML insulins (treatment group) and NEML-listed insulins (control group), with each insulin product serving as the unit of analysis. The percentage of available insulin products and their affordability for the lowest-paid worker were calculated. Non-parametric tests were performed for categorical analyses.ResultsOverall, the median price of insulins increased by 31.87% (p p ConclusionInsulin prices increased significantly following the deregulation policy, particularly for non-NEML OBs, leading to reduced affordability despite fair availability. A policy review and stronger financial protection measures are needed to ensure equitable access to insulin.