The UK’s National Institute for Health and Care Excellence (NICE) has issued a positive recommendation for Eli Lilly’s Onswik (efsitora alfa) in a move that opens the insulin jab up for national coverage, subject to marketing authorisation.
Lilly’s Onswik is a pre-filled injection pen containing insulin that only needs administering once a week. Its availability marks a big advancement for type 2 diabetic patients who rely on daily insulin injections, with initial forecasts that a switch to Lilly’s product could cut the number of injections each patient needs by 85%. It will especially help those who usually need help with their injections, such as older people, patients with learning disabilities, and those with limited hand movement.
Go deeper with GlobalData
Discover B2B Marketing That Performs
Combine business intelligence and editorial excellence to reach engaged professionals across 36 leading media platforms.
While the recommendation means Onswik will be covered on England’s National Health Service (NHS), an approval from the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) still needs to arrive first for the product to be available. A UK marketing authorisation is largely expected given the pre-emptive NICE recommendation. Onswik already secured a positive recommendation from the European Medicines Agency’s (EMA) Committee for Medicinal Products for Human Use (CHMP) in June 2026, signifying a welcome sentiment with regulators so far.
NICE based its decision on data from Lilly’s Phase III QWINT programme. Results demonstrated that Onswik controls blood glucose levels as well as two widely used long-acting insulins, insulin degludec and insulin glargine, which are taken to keep blood sugar steady throughout the day. It means people switching to the weekly injection can expect similar blood glucose control to their current treatment, NICE said.
Type 2 diabetes is a common condition where the body cannot make enough of a hormone called insulin, or the insulin it makes does not work properly. Administering insulin helps the body better regulate glycaemic levels.
Helen Knight, director of medicines evaluation at NICE, said: “Moving from daily injections to a single weekly dose could make a real difference to the day-to-day lives of people with type 2 diabetes, especially those who rely on a carer, family member or healthcare professional to help them inject. This recommendation is the result of rigorous, evidence-based decision making, striking a balance between the benefits to patients and the best use of limited NHS funding.”
The relatively straightforward decision for Onswik contrasts a rockier UK reimbursement journey for Lilly’s Alzheimer’s therapy Kisunla (donanemab). In June 2025, NICE rejected NHS use of the drug based on the narrow window of clinical benefits. Lilly appealed the decision, with NICE referring the review back to its appraisal committee in March 2026.
The UK’s reimbursement landscape has caused friction with other drugmakers recently. Bristol Myers Squibb (BMS) aligned UK and US prices for schizophrenia treatment Cobenfy, even threatening to walk away from the UK market if NICE did not recognise the drug’s clinical value.
Separately, AstraZeneca and MSD have previously halted investment for UK expansion plans in the past year, criticising an unwelcoming and uncompetitive pharmaceutical environment. Given the size of the patient population for insulin products, NICE’s nod for Onswik will be a welcome one for drugmakers.
Regardless, insulin represents a product that is far more accessible in the UK than the US. According to research, US prices for insulin products were nearly ten times as high as prices in 33 OECD comparison countries in 2022. The history of insulin coverage in the US has been dominated by complex rebate systems and a prevalence of pharmacy benefit managers.
