‘This is only the beginning of the GLP-1 journey in India’: Vikrant Shrotriya, MD of Novo Nordisk India

The June data from Pharmarack shows  the GLP-1 market recorded its first month-on-month decline after generic semaglutide drugs entered the market in March. The combined sales have slipped to Rs 227 crore in June from a record Rs 236 crore in May. Is this just a pause, or do you expect a decline in the overall market?

The market is stabilising after the initial rush. When the market opened up after patent expiry, there was a lot of noise. We believe it is now entering a more sustainable phase. Our GLP-1 business continues to grow month-on-month. There is no hockey-stick growth, there are no inventory issues and the trajectory is sustainable. We are encouraged by the growth of our GLP-1 portfolio despite the entry of generics, which is uncommon in the pharma industry.

Weight-loss brands Ozempic and Wegovy continue to grow modestly even as generic brands have stabilised. Why has Novo Nordisk outperformed the broader market?

We have been working with endocrinologists, physicians and diabetologists in India for nearly four decades, that has earned us the trust of doctors. We are not trying to capitalise on a short-term semaglutide gold rush. We have been committed to diabetes care long before it became fashionable. Our manufacturing model is also fundamentally different. Unlike many players, we control the entire value chain – the API, the device and the delivery system are all part of an integrated platform developed by Novo Nordisk. It’s an end-to-end approach, and not an assembled product sourced from multiple suppliers. Doctors and patients recognise that reliability. The competitive pricing has also helped.

Soon after semaglutide patent expired, Novo cut prices too. In hindsight, was that the right decision?

Our price reduction was not a reaction to competition but a response to patients’ need for a high-quality treatment at an affordable price. Our global headquarters fully supported that decision because improving access was more important than preserving price. Success should not be measured only by revenues. If more deserving patients receive treatment because the product is affordable, that is the right outcome.

What are your projections for Novo’s semaglutide portfolio in India over the next few years?

This is only the beginning of the GLP-1 journey in India. It has been just a year since our launch and only a few months since patent expiry. Despite the recent momentum, GLP-1 drugs have reached less than 1% of the eligible patient population. Fewer than 500,000 people in India are currently on these treatments, even as the country has around 100 million people with diabetes and about 250 million living with obesity. The opportunity is enormous, but unlocking it will require patient awareness, appropriate prescribing by doctors and improved access. As awareness improves, the penetration will increase substantially. We are still at an early stage of adoption.

Analysts estimate India’s GLP-1 market could eventually be a Rs 12,000-15,000 crore opportunity. Do you agree?

Many analysts have made projections, but nobody has a crystal ball. These are only estimates. Given the country’s significant diabetes and obesity burden, the long-term potential could be even larger. However, misinformation has created confusion. As a result, some eligible patients hesitate to seek treatment, while others who may not need these medicines are eager to use them. The priority is ensuring that eligible patients receive these treatments under appropriate medical supervision.

India is the seventh country where Novo has launched Awiqli, a once-weekly basal insulin. What does this product address?

The biggest barrier to insulin initiation has always been the burden of daily injections. With once-weekly dosing–DOSAGE–, the number of injections comes down from 365 a year to just 52. The convenience can change how patients think about insulin and encourage early treatment.

How large is that opportunity?

Only around 6 million people in India currently use insulin despite the country having more than 100 million diabetics. The number of patients requiring insulin could eventually increase to around 14-20 million. The issue is not that patients don’t need insulin, but that they postpone it for years because of the burden associated with daily injections.

Novo has said insulin initiation in India is delayed by 7-9 years. Why?

The biggest reason is fear of injections. Nine out of 10 patients are reluctant to start insulin because they have to inject themselves every day. Many deny and delay treatment even when doctors advise them otherwise. Physicians are also concerned about treatment complexity, hypoglycaemia and long-term adherence. A once-weekly dosing simplifies insulin therapy for both patients and clinicians. Despite best efforts from the doctors, just 4-5% of eligible patients are initiated on insulin each year. Once-weekly insulin can take the annual additions to 8-9%. If that happens, the number of people receiving insulin treatment could double over the next 6-7 years.

Novo already has around 20 diabetes and weight-loss products in India. Will a new brand (Awiqli) cannibalise your existing products?

Minor cannibalisation is unavoidable. Some switching from daily insulin is inevitable. But the expectation is that Awiqli will primarily expand the overall insulin market rather than replacing the existing brands. This is a volume-growth story rather than a value-growth story.

Awiqli has been priced 25-35% below existing second-generation insulins. What was the rationale behind that strategy? Does the lower pricing put pressure on Novo’s revenue growth?

Affordability is critical if you want to expand access. Awiqli was deliberately priced below existing second-generation insulins as we want more patients to benefit from this innovation. While some patients may switch from our existing products, we expect many more new patients to initiate insulin therapy because of its convenience and affordability of Awiqli.