Introduction (relevance). Type 2 diabetes mellitus (T2DM) remains a global healthcare challenge. The use of advanced innovative medicinal products (IMPs) and continuous glucose monitoring (CGM) systems is critical for preventing disease complications. However, in the Kabardino-Balkarian Republic (KBR), the accessibility of these technologies is constrained by economic and logistical barriers. Assessing the actual availability of high-tech care for patients with diabetes is a prerequisite for optimizing the regional pharmaceutical supply system. Purpose: To analyze the actual availability of innovative glucose-lowering drugs and CGM systems in the Kabardino-Balkarian Republic, identify barriers to the widespread adoption of innovative technologies, and develop practical recommendations for improving the situation. Materials and methods. The study objects were the system of preferential drug provision (PDP) for patients with T2DM in the Kabardino-Balkarian Republic. The materials included the T2DM registry data, the Ministry of Health of the KBR reports for the period 2021–2024, and public procurement records. Content analysis, comparative analysis, and statistical processing methods were applied. Accessibility was evaluated by comparing the actual consumption of IMPs and CGM systems with the regional patient needs, as well as by calculating the solvency adequacy ratio (Cas). Results. By 2024, an increase in the availability of medications within the PDP system was observed in the KBR: dipeptidyl peptidase-4 (DPP-4) inhibitors reached 39.9%, and sodium-glucose cotransporter-2 (SGLT-2) inhibitors reached 28.7%, while patient coverage with test strips reached 100%. However, a significant gap was identified in the provision of CGM systems between federal (20.2%) and regional (0.023%) benefit recipients. The high cost of glucagon-like peptide-1 (GLP-1) receptor agonists and CGM systems remains the primary barrier to accessibility for socially vulnerable populations. Discussions. It was established that regional budget funding primarily covers oral forms of DPP-4 and SGLT-2 inhibitors. In contrast, the federal benefit program provides better financing for high-cost therapy with injectable GLP-1 receptor agonists (6.8% compared to 0.4% in the regional segment). Nevertheless, a severe shortage of injectable dosage forms (GLP-1 RAs) persists across both funding channels. The provision of CGM systems and insulin pumps remains critically dependent on federal budget allocations. On a positive note, full coverage of patient needs for test strips has been achieved. Conclusions (conclusion). Despite rising personal incomes in the KBR (2021–2024), innovative medicinal products (IMPs) remain highly unaffordable for socially vulnerable groups, with treatment costs ranging from 10% to 100% of their income. While the current preferential drug provision system has shown significant progress in providing oral IMPs — specifically DPP-4 inhibitors (39.9%) and SGLT-2 inhibitors (28.7%) — there is a critical shortage of injectable forms (GLP-1 RAs at 0.4%) and CGM systems (0.023%). This disparity necessitates adjustments to territorial state guarantee programs and the development of regional co-financing mechanisms for high-tech care for these patients.