Will there be a widespread adoption of semaglutide following a price reduction?

It’s Tuesday morning. The outpatient clinic in South Delhi is busy. Forty-four-year-old accountant Vikash Solanki is with his endocrinologist. He has one question that has been on top of his mind for a few days now.

Solanki, who weighs 95 kilos despite his best efforts, came across a post on social media about a generic version of semaglutide, the injectable obesity drug that became a global phenomenon under brand names Ozempic and Wegovy. Unlike those expensive drugs, this one was priced at Rs 1,800 a month, at least ten times cheaper than the blockbusters.

Should he take the shot, he asks.

His doctor has been here before. He has been through variations of this conversation in recent weeks. In fact, the frequency has increased since March. He takes a deep breath and begins to explain the pros and cons of the so-called “wonder drug”.

For endocrinologists, this has become the default question since the expiry of patents for semaglutide. This has resulted in one of the sharpest price disruptions for the chronic therapy in recent years.

More than 20 generic manufacturers have entered the market in quick succession, according to the National Pharmaceutical Pricing Authority. And prices have fallen by as much as 90%.

There’s a rush among Indian companies—including Sun Pharma, Dr Reddy’s Laboratories, Zydus Lifesciences and Torrent Pharmaceuticals—who have already launched their generic versions. In fact, semaglutide’s innovator, Danish drug maker Novo Nordisk, has also slashed prices on starting doses of its diabetes formulation of semaglutide by 36%, and on its obesity formulation, Wegovy, by 48%.

Importantly, while semaglutide has gone off-patent, Mounjaro is still under patent in India till 2036 and is positioned as a higher-priced, next-generation therapy.

For clinicians, pharmaceutical executives and public health specialists, the harder test is whether cheaper drugs translate into wider treatment, and whether that expansion makes any difference to India’s epidemic of obesity, diabetes and cardiovascular disease.

“The branded versions were priced at Rs 15,000 or more a month, limiting use to a narrow slice of wealthy urban patients. Some generic formulations are now available for a fraction of that amount,” says health economist Arup Mitra, Professor and Dean at South Asian University. India has the infrastructure, the science and the need, he adds. “The system must now prove it is ready to absorb it.”

Besides, there are fears that the gold rush could provide unscrupulous elements an opportunity to prey on the vulnerable.

Scale of the Problem

There is no question about the need for the drug in India. According to the International Diabetes Federation’s Diabetes Atlas 2025, more than 136 million Indians live with diabetes, the largest absolute burden in the world.

Data from the Indian Council of Medical Research (ICMR)–INDIAB study published in 2023 estimates that nearly 136 million are pre-diabetic, highlighting the size of the at-risk population.

To add to that, the National Family Health Survey-5 shows that 24% of women and 23% of men in India are overweight or obese, with higher prevalence in urban areas. The World Health Organization’s (WHO’s) Global Obesity Observatory projects these numbers will rise sharply through the decade. Plus, the ICMR 2023 estimates that cardiovascular disease accounts for nearly 28% of all deaths in India.

“Taken together, these numbers point to a disease burden that existing interventions have struggled to address at scale,” says Dr Anoop Misra, Chairman of Fortis C-DOC Hospital for Diabetes and Allied Sciences and Director of the National Diabetes Obesity and Cholesterol Foundation.

“This is a social legacy that reduces both patient demand for treatment and physician willingness to initiate it. In Tier II and III cities, and across much of rural India, the framing of obesity as a disease requiring long-term medical management has barely taken hold,” Dr Misra adds.

Affordability

Novo Nordisk spent decades and significant capital developing GLP-1 therapies—medications that help lower blood sugar levels and in losing weight. The pricing reflected the investment and economics of Western healthcare systems where insurers absorbed much of the cost.

In India, where the National Health Accounts data show that out-of-pocket spending accounts for 39% of total health expenditure, those prices created an impregnable barrier for most patients.

On the other hand, India’s pharma companies—among them Sun Pharma, Torrent, Cipla and Dr Reddy’s Laboratories alongside dozens of mid-sized players—have built their businesses around reverse-engineering molecules at scale and driving down costs through optimised domestic supply chains.

The speed of entry into the semaglutide generic market, with more than 40 players filing within weeks of patent expiry, highlights both the commercial scale of the opportunity and the manufacturing depth the sector has developed here over decades.

“We have never seen these many companies move this fast into a single therapeutic category. The level of competition entering this market will compress prices further over the next 12 to 18 months,” says Rajesh Pherwani, Founder and Chief Investment Officer at Valcreate Investment Managers LLP.

However, the limited cold chain infrastructure remains a major logistical hurdle. Semaglutide is a delicate peptide that must be stored between 2°C and 8°C.

“Semaglutide is a complex protein molecule in form of a chain of amino acids. We use the advanced r-DNA technology to develop this peptide molecule which requires rigorous control at every stage to ensure product quality, stability and careful management of impurity profiles,” says Vikrant Shrotriya, MD of Novo Nordisk India.

Even so, the early pricing trends are striking. Branded semaglutide injections were priced above Rs 10,000 a month before generic entry. Many new entrants are targeting price points below Rs 2,000, with analysts projecting that sustained competition could even push costs below Rs 1,500 within 18 months.

Clinicians and health economists caution that affordability is not the only factor. A monthly cost of Rs 2,000 is accessible for a salaried professional in a major city.

“Whether the drug eventually reaches patients in district hospitals or lower-income groups will depend on insurance coverage, government procurement decisions and absorptive capacity of the public health system,” says Pherwani.

The Treatment Gap

Research by the Indian Heart Association shows that less than 50% of patients here stick to therapies for chronic conditions, including hypertension and type II diabetes.

“Patients start treatment, improve and stop. They return when symptoms worsen. The episodic pattern of care is not easily disrupted by just a cheaper drug,” says Dr Misra.

Semaglutide presents specific challenges in that context. It is injected into the fatty tissue, requiring familiarity and comfort that oral medications do not. It is intended for long-term use, with clinical trial data published in The New England Journal of Medicine showing that benefits reverse when patients discontinue.

“The drug works for eligible patients. But it must be accompanied with counselling, follow-up, adherence. Without that, patients stop after some months and it isn’t successful,” says Dr Ambrish Mithal, Chairman and Head of Endocrinology and Diabetes at Max Healthcare.

The readiness of physicians is another gap. A 2024 survey by the Research Society for the Study of Diabetes in India found that less than a third of general practitioners in non-metro cities felt confident initiating GLP-1 therapies.

The Indian Medical Association and Association of Physicians of India have flagged the need for updated prescription guidelines and structured training programmes.

At the same time, the Central Drugs Standard Control Organisation has noted a rise in complaints related to unsupervised injectable use and recently listed its potential side effects. This has been exacerbated by the unauthorised grey-market versions of the drug that appeared in early 2026, prompting a crackdown on clinics selling unverified peptides. “It is a serious medication and we continue to make every effort to ensure that it remains under medical supervision,” says Shrotriya.

The Ripple Effects

Though much of the attention on semaglutide has been focused on its ability to help shed weight, its clinical case extends well beyond that. Trial data published in The New England Journal of Medicine’s SELECT study showed a 20% reduction in major cardiovascular events in overweight and obese adults without diabetes who were treated with semaglutide. Recent evidence from Indian clinics also supports its use in managing non-alcoholic fatty liver disease, a condition that can cause the liver to swell and lead in extreme cases to cirrhosis.

The hospital sector is watching closely. This is because interventions like bariatric surgery to treat obesity have increased steadily in Indian cities over the past decade. Data from the Obesity and Metabolic Surgery Society of India shows the number of procedures has roughly doubled since 2018, though it remains a niche intervention.

As a medical alternative becomes more affordable, some surgeons expect the risk-benefit calculation for borderline surgical candidates to shift. Others are more confident that surgery will remain relevant for severe obesity cases.

“Bariatric surgery will continue to have a role, especially in severe obesity. While injections are expanding treatment options, they typically need to be taken long term, whereas surgery is a one-time intervention,” says Dr Pradeep Chowbey, Chairman of Max Institute of Laparoscopic, Endoscopic and Bariatric Surgery. “In many cases, we also use these therapies to prepare patients for surgery, rather than replace it entirely.”

In diagnostics, the impact is more direct. Structured drug-led weight management programmes require testing and regular monitoring. Metropolis has introduced three structured, scientifically curated test packages under its GLP-1 series. “As GLP-1 therapies gain traction across India, they must be supported by a reliable diagnostic framework,” says Surendran Chemmenkotil, Managing Director of Metropolis Healthcare Ltd.

In the food and nutrition sector, research from Euromonitor International shows that GLP-1 drug adoption in the US has already begun to affect sales in high-calorie snack and beverage categories.

Real Challenge

India’s generic pharma sector is well placed to supply semaglutide at scale and at an accessible .

The real challenge now lies in converting access into long-term outcomes at scale, experts say. A report by the Public Health Foundation of India published in 2025 identifies physician training, patient awareness and insurance coverage as the three structural constraints.

Data from the Insurance Regulatory and Development Authority of India shows that metabolic and obesity-related therapies are largely excluded from retail health insurance policies. “In India, the ‘medicalisation’ of obesity or semaglutide is still recent. I hope that over time obesity treatment gets coverage,” says Shrotriya.

“The insurance gap is critical. Without coverage, lower prices will not translate into sustained use,” Mitra says.

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