Nearly all early all lower-and-middle income countries (LMICs) have included both intermediate-acting and short-acting human insulin in National Essential Medicines List. Lack of access to insulin and poor health outcomes are still problematic in both low and high income countries. In LMICs the main issue is that insulin is either unavailable or unaffordable. The insulin market is a difficult to understand and lacks transparency. For example, in 2014, a global surplus of 67.6 million vials of insulin was reported. This suggests that supply of insulin isn’t the cause of the global lack of access to insulin. UCAB is exploring ways to produce improve access to an affordable, high-quality insulin biosimilar.