Eli Lilly’s once-weekly injectable insulin, Onswik, has received a positive recommendation from the UK’s drug cost watchdog, moving it closer to NHS availability for type 2 diabetes patients.
The National Institute for Health and Care Excellence, known as NICE, assesses whether a new drug’s price-to-benefit ratio justifies coverage through the publicly funded National Health Service.
A positive NICE recommendation means hundreds of thousands of patients with type 2 diabetes could eventually switch to a weekly injection, reducing their annual injections by 85%.
A Lilly spokesperson confirmed the pharma is now “awaiting a decision from the MHRA on marketing authorization” before the drug can be formally approved in Britain.
NICE’s final draft guidance noted that Onswik could be particularly valuable to patients who need assistance with insulin injections due to sight loss, frailty, limited hand movement, or difficulty following necessary steps.
Switching to weekly injections could also reduce patient dependence on caregivers and healthcare workers, offering more flexibility in their day-to-day lives, NICE added.
“This recommendation is an important step towards giving people with type 2 diabetes greater flexibility in how their condition is managed,” said Douglas Twenefour, head of clinical at Diabetes UK.
Younger patients with type 2 diabetes may also benefit from Onswik if the weekly schedule helps them better balance treatment demands with their working lives.
NICE based its recommendation on data from Lilly’s late-stage QWINT-1, QWINT-3, and QWINT-4 clinical trials, which demonstrated non-inferior A1C reduction compared to daily insulin across multiple patient groups.
Overall, Onswik controlled blood glucose as effectively as two commonly used daily insulins, insulin degludec and insulin glargine, while maintaining a similar safety profile throughout the trials.
“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,” said Helen Knight, director of medicines evaluation at NICE.
The endorsement arrives amid significant tension between major pharmaceutical companies and NICE over cost-effectiveness evaluations and their influence on medicine pricing in the UK.
Last year, Merck and AstraZeneca paused expansion plans in the UK, citing an inhospitable environment for drugmakers, while Bristol Myers Squibb threatened to withhold a drug from the NHS over pricing disagreements.
By the end of 2025, corporations had pulled 2 billion pounds, equivalent to $2.7 billion, in planned investments from the country as disputes over drug pricing intensified.
A US-UK pharma trade deal struck in December and finalised this spring partially resolved the standoff, with the UK subject to 0% tariffs on pharmaceutical exports to the US until 2029.
In return, the NHS must raise spending on new medicines by roughly 25% and NICE must increase its price ceiling, paving the way for a higher cost-effectiveness threshold going forward.
Onswik had already earned a favourable recommendation from the European Medicines Agency’s Committee for Medicinal Products for Human Use earlier this summer, though it still awaits final sign-off from the European Commission.
Lilly could also receive an FDA decision on its long-acting insulin before the end of the year, potentially opening up the crucial US market for the weekly treatment.