Ozempic, Wegovy: India’s cheap weight-loss drugs could reshape the global fight against obesity

India could soon become a lot leaner – at least in theory.

On Friday, the patent for semaglutide – the molecule behind the successful weight loss drugs Wegovy and Ozempic from Danish manufacturer Novo Nordisk – expires in the country.

This will allow domestic pharmaceutical companies to market cheaper copies or generics, triggering a rush of competition that could cut prices by more than half and rapidly expand access to drugs in India, and potentially other countries as well.

Investment bank Jefferies called this a potential “magic moment” for India, predicting that the semaglutide market could eventually reach $1 billion domestically with the right pricing and adoption.

Analysts expect around 50 branded semaglutide generics to enter the market within months – a familiar trend in India’s fiercely competitive pharmaceutical industry. When the diabetes drug Sitagliptin lost its patent in 2022, about 30 branded versions appeared in a month and almost 100 in a year.

India’s pharmaceutical industry, currently worth about $60 billion, is expected to double by 2030. Much of its industry relies on generics – a manufacturing muscle that is now paving the way for fierce competition for semaglutide. What has until now been an expensive injection, largely reserved for wealthy patients, could soon become much more common.

Originally developed to treat diabetes, these drugs are now hailed as revolutionary in weight loss, delivering results that few previous treatments could match. Semaglutide belongs to a class of drugs called GLP-1 receptor agonists, which mimic a hormone that regulates appetite and blood sugar levels.

By increasing the release of insulin and slowing stomach emptying, the medications make people feel full sooner and stay that way longer. Originally developed for diabetes, they have become among the most sought-after weight loss treatments in the world.

Several Indian pharmaceutical laboratories are already preparing to take the plunge. According to Sheetal Sapale, vice-president of research firm Pharmarack, major companies including Cipla, Sun Pharma, Dr Reddy’s Laboratories, Biocon, Natco, Zydus and Mankind Pharma are preparing branded generics, with many more likely to follow. Prices are expected to fall sharply.

Current monthly costs for the treatment are high: Ozempic typically sells for 8,800 to 11,000 rupees ($95 to $119; £71 to 89), while Wegovy can cost between 10,000 to 16,000 rupees ($108 to $173). Sapale expects generic competition to bring that price down to around 3,000 to 5,000 rupees ($36 to $54) per month.

Lower prices could transform the market.

India’s anti-obesity drugs sector – covering both injectable and oral medications – has already seen rapid growth, from around $16 million in 2021 to almost $100 million, according to Pharmarack. Demand accelerated after the launch in 2022 of Rybelsus, the first oral version of semaglutide.

This increase reflects a broader change in health.

India already has more than 77 million people with type 2 diabetes and one of the largest populations of overweight adults in the world. Urban lifestyles, high-carbohydrate diets and sedentary habits have contributed to both conditions.

For doctors, cheaper GLP-1 drugs could soon provide a powerful new tool to treat them.

Weight loss drugs are also expanding beyond endocrinology clinics. Cardiologists use them to help patients lose weight before procedures such as angioplasty, orthopedic surgeons to reduce stress on joints before knee surgery, and pulmonologists to treat conditions such as obstructive sleep apnea.

Muffazal Lakdawala, a Mumbai-based bariatric surgeon, says these drugs could significantly expand treatment for India’s large population of patients with diabetes and obesity.

Until recently, he notes, access was limited: injectable GLP-1 drugs were expensive and difficult to obtain, while the oral drug Rybelsus was the only widely available option.

“It’s great that these products are becoming cheaper so that more Indian diabetics and obese people can have access to them,” he says.

But he adds a warning: “The quality of medicines manufactured here must be very strictly regulated.”

This caution reflects a broader reality about the Indian pharmaceutical industry – the global powerhouse of low-cost generic drugs.

The country is the world’s largest supplier of generic medicines, producing around 60,000 brands across more than 60 therapeutic categories and accounting for around 20% of the global supply of generic medicines.

Its reputation as the “pharmacy of the world” is largely based on its ability to transform expensive drugs into affordable mass-market products.

The most famous example occurred two decades ago, when Indian companies helped reduce the price of antiretroviral HIV drugs, significantly expanding treatment in Africa and the developing world.

Today, India supplies medicines to more than 200 countries, meeting more than half of the demand for generic medicines in Africa, around 40% of the generic medicines used in the United States, and around a quarter of the medicines in the United Kingdom.

“The export potential of Indian generic weight loss medicines is huge,” says Namit Joshi, chairman of the government’s Pharmaceutical Export Promotion Council of India. “The U.S. market alone could reach $10 billion within a few years as obesity rates drive demand.”

This would represent a considerable addition to India’s pharmaceutical trade: the country’s generic drug exports currently total $30.46 billion, with the United States already its largest market.

But doctors’ enthusiasm remains tempered by caution.

GLP-1 drugs are powerful but not without risk. Side effects may include nausea, vomiting and digestive problems; rarer complications include gallstones or pancreatitis. Rapid weight loss without adequate protein intake and exercise can also lead to muscle loss.

Doctors say many patients misunderstand the role of medications. Some expect dramatic weight loss within weeks, influenced by social media hype and celebrity support.

Mumbai-based diabetologist Rahul Baxi says success depends not only on the drug but also on “proper patient selection”.

Doctors look beyond body mass index (BMI) – a basic measure of weight in relation to height – and also look at related conditions such as diabetes or high cholesterol. Lifestyle also matters: If a patient’s diet remains unhealthy, the medication alone may not be enough.

Patients often arrive looking for a quick solution. “People come asking to lose 10 kg in three months,” explains Baxi.

Rapid weight loss can have downsides. Too quickly, patients risk losing fat from the face, neck, arms and thighs, which will make them fragile.

“Gradual weight loss, slowly increasing the dose, and focusing on protein intake, exercise, and strength training are key to achieving healthier results,” says Baxi.

Another challenge is that weight loss often reverses once medications are stopped. Appetite can rebound sharply as the body resists fat loss.

“If you stop taking medication, the appetite comes back voraciously,” says Baxi.

Concerns also remain about misuse as prices fall.

Doctors report that gym trainers, beauty clinics or dietitians have prescribed high doses to their patients without authorization to do so. Online pharmacies sometimes deliver medications after brief consultations. Beauticians are already advertising quick slimming “packages” for weddings or social events.

Such practices could spread as cheaper generics become more widely available.

“Better access to cheap drugs means a higher risk of abuse,” says Bhaumik Kamdar, a Mumbai-based pulmonologist. “Access requires more accountability – and stricter regulation. I am cautiously optimistic about these drugs.”

This warning echoes Lakdawala’s concerns about manufacturing standards.

“These are very beneficial medications,” he says. “We don’t We don’t want side effects resulting from poor quality drugs and giving a bad reputation to the molecule itself.”

The government is also trying to temper this media hype. In an advisory issued last week, India’s drug regulator warned pharmaceutical companies against promoting prescription weight-loss drugs such as GLP-1 drugs directly to consumers.

Advertisements that promise dramatic results or downplay the need for diet and exercise could be considered misleading, officials said, emphasizing that such drugs should only be used under medical supervision.

For regulators and doctors alike, the coming months could therefore test whether India can reconcile financial accessibility and surveillance.

Baxi says he asks patients to improve their lifestyle and diet before prescribing weight-loss drugs.

Even then, they are first put on a high-protein diet with the help of a dietician, he says. Current data suggests that the medications may need to be taken over a long period of time. But many patients arrive asking for a “quick fix after seeing Instagram Reels”, putting pressure on doctors.

Still, the rewards could be significant. A drug that once cost tens of thousands of rupees a month could become available to millions of people – and perhaps eventually to patients far beyond India.

“Actually, I write about many patients’ prescriptions: come see me after March 20, when prices drop,” says Baxi.