Europe Insulin Drug Market

Sanofi’s European sales of Lantus fell 12.4% at constant exchange rates to EUR 297 million in 2025 while its newer basal insulin Toujeo rose 4.4% to EUR 500 million, according to Sanofi’s full-year 2025 results filed with the SEC; Novo Nordisk’s insulin sales in Europe and Canada fell 4% to DKK 12,910 million, its 2025 financial report shows. Old insulin brands are leaving Europe faster than new ones arrive. The Europe insulin drug market covers human and analogue insulins, including once-weekly basal insulin and basal insulin combinations, sold for use in Europe, valued at manufacturer net prices. Douglas Insights sizes it at USD 4.89 billion in 2025, from 9.60 million insulin patient-years at an average net USD 509 each, and at USD 5.93 billion in 2035, a revenue CAGR (compound annual growth rate) of 1.95%. It is the Europe row of our global Insulin Drug Market report, sits in our pharmaceuticals coverage, and every figure follows the Douglas Insights research methodology.

Which insulin class carries the most value: long-acting, rapid-acting, human or premix?

Long-acting insulin analogues carry the most value, 45.2% of the 2025 Europe insulin drug market, USD 2.21 billion, and grow fastest, 3.10% a year to USD 3.00 billion, because weekly basal insulin and basal combinations replace daily brands.

Long-acting analogues, USD 2.21 billion, lead because basal insulin is the first injectable step for most of the 66 million European adults with diabetes who progress beyond tablets. Sanofi’s Toujeo, Lantus and Soliqua, Novo Nordisk’s Tresiba, Xultophy and Awiqli, and Lilly’s Abasaglar all compete here. The class grows 3.10% a year, the fastest of the four, because Novo Nordisk’s once-weekly icodec and Lilly’s once-weekly efsitora alfa enter at brand prices while Levemir leaves.

Rapid-acting analogues, USD 1.63 billion, are mealtime and pump insulins such as NovoRapid, Fiasp, Humalog, Lyumjev and Apidra; they grow 1.55% a year as more people with type 1 diabetes use pumps, offset by aspart and lispro copies. Human insulin, USD 552 million, is 11.3% of value, more than in the United States, because Russia, Turkey, Poland and other eastern markets still use it widely; it shrinks 0.90% a year as Novo Nordisk’s human insulin sales fell 18% worldwide in 2025 and Lilly withdraws Humulin presentations. Premix insulins, USD 494 million, grow 0.30% a year as prescribers move patients to basal-plus regimens. Class values for 2035 sum to USD 5.91 billion, 0.22% below the headline.

By diabetes type, Douglas Insights estimates that type 2 diabetes carries about 60% of 2025 value and type 1 diabetes about 40%, since the International Diabetes Federation counts about 2.7 million people with type 1 diabetes in its Europe region. By delivery format, prefilled pens carry about 78% of value, cartridges for reusable pens and pumps about 15% and vials about 7%, because European health systems moved to pens long before the United States. By channel, retail pharmacies dispense about 80% of value and hospital pharmacies about 20%.

What drives insulin sales up 1.95% a year when 2025 sales fell?

More treated patients drive the Europe insulin drug market: patient-years rise 1.30% a year, from 9.60 million in 2025 to 10.9 million in 2035, and net price per patient-year rises 0.64%, as weekly basal insulin offsets biosimilar glargine.

The International Diabetes Federation counts about 65.6 million adults aged 20 to 79 with diabetes in its Europe region in 2024, 33.6% of them undiagnosed, and expects 72.4 million by 2050, according to its Diabetes Atlas Europe data. Spending on diabetes in the region is about USD 193 billion a year, so insulin is about 2.5% of the bill. Four drivers add 2.10 gross points to volume and 1.90 points to price.

Diagnosed type 2 diabetes: 1.10 points of volume

Prevalence adds 1.10 points. An ageing population and higher body weight raise the number of type 2 patients who exhaust oral drugs, and finding part of the 22.0 million undiagnosed adults adds starts. Douglas Insights estimates that about one in six Europeans with diagnosed diabetes uses insulin.

Type 1 technology and access: 0.60 points of volume

Pumps and continuous glucose monitors add 0.60 points, as automated insulin delivery keeps more people with type 1 diabetes on rapid-acting insulin and in care. National programmes such as England’s hybrid closed loop rollout widen access. Pump hardware is sized separately in our Insulin Pumps Market report.

Eastern access: 0.40 points of volume

Wider access in Turkey, Poland, Russia and the Balkans adds 0.40 points, as those systems move patients from human insulin to analogues and treat more people earlier.

Weekly basal and pen upgrades: 1.90 points of price

Weekly basal insulin adds 1.10 points of price, combinations such as Soliqua and Xultophy 0.40 points and the switch from vials to pens 0.40 points. Sanofi’s European Soliqua sales rose 6.3% to EUR 51 million in 2025 in the same filing that showed Lantus falling, which is the price leg in one line: newer formats grow while old brands erode.

What holds back insulin value: biosimilar glargine, withdrawn brands or GLP-1 drugs?

Three restraints hold back the Europe insulin drug market: GLP-1 drugs remove 0.80 points of volume, biosimilar and tender pressure removes 1.00 point of price, and brand withdrawals plus Germany’s 2027 rebate remove 0.26 points more.

Glucagon-like peptide-1 (GLP-1) drugs such as semaglutide and tirzepatide delay the moment a type 2 patient needs insulin, so fewer patients start basal therapy than prevalence alone implies; Douglas Insights removes 0.80 points, leaving the 1.30% net volume leg. Lilly is shifting its own focus to that class, which is why its insulin range is shrinking.

On price, biosimilar insulin glargine, lispro and aspart remove 1.00 point a year. The European Commission approved Sandoz’s Ondibta, an insulin glargine developed by Gan & Lee, on 14 January 2026, with launch expected by early 2027, Pharmafile reported, and the European Medicines Agency (EMA) overview confirms it matches Lantus. Every new copy lowers the price that national tenders and hospital buyers accept. Brand withdrawals remove 0.11 points because patients switched off Levemir and Lilly presentations sometimes move to cheaper insulins, and Germany’s higher statutory rebate removes 0.15 points from 2027. Gross price growth of 1.90 points, less 1.26 points, leaves 0.64%.

The 2025 numbers show the restraints at work: Novo Nordisk said the 4% fall in its Europe and Canada insulin sales was driven mainly by long-acting and human insulin, and its volume share there slipped from 45.3% to 44.5%.

Where in Europe is insulin used most: Germany, France, the UK or Turkey?

Germany uses the most insulin in Europe, USD 958 million or 19.6% of 2025 value, almost twice France’s USD 547 million. Turkey grows fastest, 3.60% a year to USD 341 million by 2035, as access widens.

Germany, USD 958 million, leads on the largest diabetic population in Western Europe and high analogue use, but grows only 1.35% a year: reference prices, the higher manufacturer rebate from 2027 and early biosimilar uptake hold back insulin value even as patient numbers rise. France, USD 547 million, grows 1.60% as the national pricing committee keeps cutting older brands. The United Kingdom, USD 508 million, grows 1.95% on hybrid closed loop access for type 1 patients, even as Levemir leaves the NHS by the end of 2026.

Turkey, USD 240 million, grows fastest at 3.60% because its fixed euro rate for drug prices is updated and more patients reach analogues. Russia, USD 430 million, grows 2.55% on a large human insulin base and local makers such as Geropharm. Italy, USD 464 million, grows 1.70%; Spain, USD 347 million, 2.05% on a fast-ageing population; Poland, USD 200 million, 2.35%, where Bioton still makes human insulin. The Rest of Europe, USD 1.19 billion, includes the Nordics, Benelux, Austria, Switzerland and the Balkans, and grows 2.05%. Country values for 2035 sum to USD 5.94 billion, 0.14% above the headline; in the data table the row labelled Global holds the Europe total, USD 4.89 billion in 2025.

Who supplies the insulin: Novo Nordisk, Sanofi, Lilly or the biosimilar makers?

Novo Nordisk supplies the most insulin in Europe, about 41.0% of 2025 value, USD 2.00 billion, Douglas Insights estimates. With Sanofi at about 22.0% and Lilly at about 21.0%, three originator companies hold 84.0% of value.

The shares are Douglas Insights estimates, because no company reports European insulin sales alone. Novo Nordisk’s EUCAN segment, Europe and Canada, booked DKK 12,910 million of insulin in 2025, USD 1.96 billion at DKK 6.60 per dollar, with a 44.5% volume share in November 2025, its 2025 financial report states; Russia and Turkey sit in other Novo regions, so our Europe estimate is USD 2.00 billion. Sanofi’s three named insulins sold EUR 848 million in Europe, USD 958 million at USD 1.13 per euro, or 19.6% of our total before Apidra and Insuman.

Lilly does not report European insulin sales, so its 21.0% is an estimate, and it is falling: the EMA said in March 2026 that Lilly will remove several presentations of Humalog, Humulin, Lyumjev and Abasaglar from selected European countries before the second quarter of 2027, Fierce Pharma reported. Sandoz and Gan & Lee, with glargine approved and lispro and aspart covered by their 2018 agreement, are the companies most likely to take that share. The ranking of these companies across all medicines is in our Europe Pharmaceutical Drug Market report.

What does a year of insulin cost a payer, from tendered glargine to weekly icodec?

A European insulin patient-year earned manufacturers an average net USD 509 in 2025, about USD 42 a month, Douglas Insights estimates: 40% below the USD 847 U.S. average and close to the USD 521 global average.

The bands are Douglas Insights estimates at manufacturer net prices after statutory rebates and tender discounts, for a typical basal dose of about 40 units a day. European prices are set by national bodies, so the same pen can cost a quarter less in Spain or Poland than in Germany. The average rises to USD 512 in 2026 and USD 543 in 2035, a 0.64% yearly gain, because each move from human insulin or daily glargine to a weekly or combination product raises spend per patient more than biosimilar tenders cut it. Global price trends are compared in our U.S. Insulin Drug Market report, where net price falls 0.40% a year.

Which EU rules shape insulin: HTA, the pharma package or Germany’s 15.5% rebate law?

Three sets of rules shape the Europe insulin drug market: national benefit assessments such as Germany’s 20 February 2025 verdict on icodec, the EU pharma package agreed on 11 December 2025, and Germany’s 15.5% manufacturer rebate law from 2027.

Germany’s Federal Joint Committee (G-BA) found on 20 February 2025 that insulin icodec showed no added benefit over existing basal insulin in type 1 or type 2 diabetes, and noted more severe hypoglycaemia than degludec in type 1, its decision rationale states. Without added benefit, the weekly insulin’s German price is negotiated against daily comparators, which caps the price premium Douglas Insights assumes for weekly basal insulin across Europe.

The Council and Parliament reached a provisional deal on the EU pharmaceutical package on 11 December 2025, reshaping data and market protection periods, according to the Council of the EU; for insulin, where the main molecules are off patent, the package matters mostly for weekly products and their future copies. The Bundestag passed a law on 10 July 2026 raising the statutory manufacturer rebate on branded medicines from 7% to 15.5% from 1 January 2027, the Federal Ministry of Health reported; insulins under reference prices are less exposed, so we remove 0.15 points of price.

Product decisions complete the rule set. The EMA’s medicines committee (CHMP) adopted a positive opinion on Lilly’s Onswik, insulin efsitora alfa for adults with type 2 diabetes, on 25 June 2026, with the European Commission decision pending, the EMA states. Under the EU’s Health Technology Assessment (HTA) Regulation, applied from January 2025, joint clinical assessments start with cancer drugs and widen to all new medicines by 2030, so weekly insulins launched now still face 27 national appraisals.

What if weekly insulin wins or GLP-1 drugs delay insulin longer: where does the market land in 2035?

The Europe insulin drug market ends 2035 between USD 4.84 billion and USD 6.85 billion across our three cases, around a base of USD 5.93 billion. Weekly basal uptake and biosimilar tender prices set the spread.

In the slower case GLP-1 drugs keep most type 2 patients off insulin for years, Ondibta and later aspart and lispro copies win national tenders quickly, and weekly insulins stay a niche after negative benefit verdicts like Germany’s. In the faster case Onswik and Awiqli win reimbursement in most countries and doctors start insulin earlier. One extra point of yearly volume growth adds USD 612 million to 2035 value; one point less removes USD 560 million.

Our 1.95% base matches the Europe row of our global insulin model and sits below the 2.46% global rate, because Asia Pacific adds patients faster while Europe’s 2025 sales were falling at Novo Nordisk and in Sanofi’s Lantus line.

Douglas Exclusive: the Insulin Withdrawal and Entry Ledger

The Insulin Withdrawal and Entry Ledger is a Douglas Insights model built from 12 dated inputs in 9 regulator, company and health-system documents of 2025 and 2026, weighing insulin brands leaving Europe against those arriving.

The finding, a Douglas Insights estimate: about USD 391 million, 8.0% of 2025 Europe insulin value, sits in presentations already announced for withdrawal by the second quarter of 2027, Levemir and Lilly’s listed Humalog, Humulin, Lyumjev and Abasaglar packs, according to the UK Levemir discontinuation notice and the EMA notice. Patients must switch, and each switch is a tender decision. We expect about 60% of that value to move to other originator brands, 25% to biosimilars and 15% to be lost as patients move to cheaper human insulin or GLP-1 drugs. Withdrawals cost the market about 0.11 points of price a year, while the two weekly entries add more, so Europe’s insulin bill keeps rising even as its brand list shrinks.

How does the methodology turn 9.60 million patient-years into USD 4.89 billion of insulin?

Our methodology multiplies 9.60 million insulin patient-years used in Europe in 2025 by an average net USD 509 per patient-year to reach USD 4.89 billion. Patients come from International Diabetes Federation counts; price from company filings.

The model covers 9 countries or sub-regions, 4 insulin classes, 2 diabetes types, 3 delivery formats and 2 channels, and uses 64 data points, 15 sourced and 49 modelled. Arithmetic: 9.60 million x USD 509.08 = USD 4,887 million, or USD 4.89 billion; 4.89 x (1.0130 x 1.0064)^10 = USD 5.93 billion. Patient-years reach 9.72 million in 2026 and 10.9 million in 2035. About 2.7 million people with type 1 diabetes make up 28% of patient-years.

Two cross-checks agree. First, Novo Nordisk’s USD 1.96 billion of Europe and Canada insulin and Sanofi’s USD 958 million of named European insulins sum to 60% of our total, leaving a plausible USD 1.97 billion for Lilly, Sanofi’s unreported lines, Russia, Turkey and the biosimilar makers. Second, USD 4.89 billion equals the Europe row of our worldwide insulin model, and our 1.95% matches it. AI tools help draft the text and automated checks test the arithmetic and links; the Douglas Insights research desk chooses the sources, builds the model and approves publication, as our editorial standards explain.

Sources

1. Sanofi / SEC Q4 and full-year 2025 results (Form 6-K) (2026)
2. Novo Nordisk / SEC Financial report for 2025 (Form 6-K) (2026)
3. International Diabetes Federation Diabetes Atlas: Europe region data (2025)
4. European Medicines Agency Onswik (insulin efsitora alfa): opinion (2026)
5. European Medicines Agency Ondibta: EPAR medicine overview (2026)
6. Gemeinsamer Bundesausschuss (G-BA) Insulin icodec: tragende Gruende zum Beschluss (2025)
7. GOV.UK Discontinuation of Levemir Penfill and Levemir FlexPen (2025)
8. Council of the European Union Pharma package: Council and Parliament reach a deal (2025)
9. Bundesministerium fuer Gesundheit Bundestag beschliesst GKV-Beitragssatzstabilisierungsgesetz (2026)
10. Fierce Pharma Lilly to remove certain insulin products from European markets by 2027 (2026)
11. Pharmafile Sandoz' Ondibta receives European Commission approval (2026)

Which insulins does this study count, and what does it leave out?

The Europe insulin drug market counts manufacturer net sales of human and analogue insulins, weekly basal insulins and fixed-ratio basal combinations used in Europe, including Russia and Turkey. Glucagon, GLP-1 drugs alone, pumps and pharmacy margins stay out.

The by-class split covers long-acting insulin analogues, rapid-acting insulin analogues, human insulin and premix insulins; Soliqua and Xultophy count in long-acting. The by-diabetes-type split covers type 1 diabetes and type 2 diabetes. The by-format split covers prefilled pens, cartridges and vials. The by-channel split covers retail pharmacies and hospital pharmacies. The by-country split covers Germany, France, the United Kingdom, Italy, Russia, Spain, Turkey, Poland and the Rest of Europe. Values are net of statutory rebates, clawbacks and tender discounts, and are counted where the insulin is used.