Insulin in Jamaica: the Fair Trading Commission's monopoly ruling

Three insulin brands, two distributors, one buyer

Every vial and pen of insulin a Jamaican patient uses comes through a very small number of hands. When Massy Holdings agreed in February 2025 to sell 100 per cent of Massy Distribution (Jamaica) Limited to Acado Limited, a 50/50 joint venture of Trinidad-based Agostini Limited and Barbados-based Goddard Enterprises, the Fair Trading Commission (FTC) looked at who distributes what². Acado had no Jamaican presence of its own, but Agostini already owned Aventa Jamaica (formerly Health Brands), which was reported in 2023 as the leading distributor in Jamaica's pharmaceutical and medical products market²³. Aventa distributes Eli Lilly's products; Massy distributes Novo Nordisk's and Sanofi's¹.

The Commission added that "the proposed transaction would create a monopoly distributor for these brands"². After a 30-day review it moved the deal into a second phase in June 2025 to decide whether it was likely to lead to "a substantial lessening of competition"³, and on 27 May 2025 it had already formally notified the parties and opened negotiations on keeping insulin accessible and affordable².

What the Fair Trading Commission found

The FTC's ruling, released in February 2026 and reported by The Gleaner, is unusually blunt for a competition document. It found that Health Brands distributed about $30 billion of intermediate-acting insulin in 2024, 81 per cent of the market, with Massy Distribution holding the remaining 19 per cent (the paper said these figures were redacted in the public document but surfaced when its text was copied)¹. The merger would give 100 per cent market share in key sub-markets, and four of the five insulin sub-markets would reach a Herfindahl-Hirschman Index of 10,000, the maximum possible¹. The Commission warned that moving from a duopoly to a monopoly "could lead to higher prices"¹.

The Commission also explained why the market would not correct itself. It described insulin demand as "price-inelastic since it is a life-saving product with limited alternatives", pointed to "consumer inertia" among doctors, insurers and patients who resist switching, and found a "significant impediment to entry": no new distributor had appeared despite significant revenues¹. The Observer reported that the National Health Fund (NHF) lists 35 insulin-related products that it subsidises for users².

The conditions: an independent distributor by September 2026

The FTC issued a statement of non-objection in February 2026, and the acquisition was expected to take effect on 1 March 2026⁴⁵. The conditions are specific. Acado must transfer the Eli Lilly brand to a fully independent distributor by September 2026; the new distributor must have no affiliation with any party to the transaction; until the handover Acado and Aventa must "maintain the full economic viability, marketability, and competitiveness" of the Eli Lilly insulin business; and an independent monitor must file monthly reports on sales volumes and pricing with the FTC¹. Trinidad's Guardian reported that Aventa "will discontinue distribution of the Eli Lilly insulin portfolio, once transition arrangements are completed", and that Cari-Med Group had been proposed as the new distributor, with the transition expected to finish by September 2026⁵. FTC executive director David Miller told The Gleaner that a duopoly supports competition in ways a monopoly cannot, and that the intervention "preserved the conditions for competition"¹.

Why insulin markets need watching

Jamaica's diabetes burden makes this more than a business story. The third Jamaica Health and Lifestyle Survey (2016–2017) found that "one in every eight people, 15 years and older, has diabetes" and that four in 10 people with diabetes did not know it⁸. A 2026 analysis of the same survey's 1,185 rural adults put diabetes prevalence at 12.8 % and obesity at 28.9 %⁷. The NHF says diabetes is one of 28 chronic illnesses it covers, with subsidies for approved diabetes medication, tests and supplies⁹.

The global evidence is consistent: concentration and price are the main barriers to insulin. Fifteen insulin price and availability surveys in 13 low- and middle-income countries found that a low-income worker needed 4 days' wages to buy 10 mL of human insulin and 7 days' wages for analogue insulin, and recommended "increasing competition through the use of lower priced quality-assured biosimilars" and improving distribution systems⁶. The WHO's 2021 report on insulin found that "three multinational companies control more than 90% of the insulin market" and that "one out of every two people needing insulin for type 2 diabetes does not get it", and it called for regulating prices and mark-ups and pooled procurement¹⁰¹¹. Distribution is the last link in that chain, and in a small market it can be held by one or two firms.

What it means for physicians and patients

For prescribers, the ruling is a reminder that brand choice in Jamaica is narrow and supply can hinge on a few contracts. Hurricane Melissa showed how fragile that chain can be: after the storm Direct Relief sent the Diabetes Association of Jamaica a year's insulin for about 300 children with type 1 diabetes, and its chairman said the NHF "can distribute the insulin on the spot"¹². Whether the handover met the September 2026 deadline, and what the FTC's monthly monitoring reports show, are the things to watch; whether prices move after the handover is the test of whether the remedy worked.