With India primed for newer and cheaper GLP-1 drugs, with some already having hit the market – thanks to the expiry of the patent on semaglutide, the molecule behind Danish drugmaker Novo Nordisk’s blockbuster weight-loss drugs Wegovy and Ozempic, on March 20 – experts believe that the latest development could reshape the fight against ‘diabesity’ and ease the country’s huge metabolic disease burden.
As per data from an Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study, about 101 million Indians are living with diabetes and 136 million with prediabetes. The same report also highlighted an enormous parallel burden of excess weight, estimating about 254 million people with generalised obesity and 351 million with abdominal obesity.
GLP-1 (Glucagon-like peptide-1) receptor agonists such as semaglutide are considered a highly effective class of drugs for managing type 2 diabetes and promoting significant weight loss. They are being hailed by many as game changers, as they have been found to offer results that other previous treatments could not match.
So far, prices of Ozempic and WeGovy, two of the currently available weight-loss drugs in the country, were priced anywhere Rs 8,000 and Rs 16,000 or more, besides Rybelsus, which is an oral tablet, coming for Rs 2,300 to Rs 3,300.
Melting the Affordability Barrier
On Saturday, after the expiry of Novo Nordisk’s patent, seven pharma companies launched generic, cheaper versions of semaglutide, ranging from Rs 1,290 to Rs 4,200 per month. These prices are nearly 65-90% cheaper than the patented drug that was available thus far.
As per Dr AK Jhingan, senior director, Centre for Diabetes, Thyroid, Obesity and Endocrinology, BLK-MAX Super Speciality Hospital, New Delhi, the high cost of treatment has remained a major factor leading to the lack of access, “which makes long-term therapy difficult for many patients in India”.
Dr Saptarshi Bhattacharya, senior consultant, endocrinology, Indraprastha Apollo Hospitals, adds: “Some of the users have had to stop taking these medications due to the cost factors as well as unrealistic expectations.”
However, the drastically reduced prices may now act as an incentive for many patients to begin these therapies, who could not afford them earlier. Pharma companies like Zydus Lifesciences, Sun Pharma, Cipla, Dr Reddy’s Labs and Alkem, among others, have all thrown their hats in the ring, and have introduced semaglutide with much reduced prices – especially now that the main patent held by Novo Nordisk has expired.
With the entry of newer drugs, and generics set to get cheaper by over 50%, it will now melt the affordability barrier for many Indian patients, Dr Ambrish Mithal, chairman and head of endocrinology and diabetes at Max Healthcare, earlier told FE.
“Making GLP-1 therapies more affordable is a must, considering that obesity and diabetes are increasingly becoming major issues in our country. These two have a high probability of causing complications such as heart, liver and kidney problems,” says Dr Bhattacharya, adding, “At present, due to the high cost of these medicines, only a handful of people have access to them. If made more affordable, it may be easier to manage these two conditions in a larger number of people.”
As cost comes down, the number of prescriptions for these drugs is also expected to increase gradually, he adds.
Dr Tarun Mittal, vice-chairperson, laparoscopic and robotic bariatric surgery, Sir Ganga Ram Hospital, New Delhi, too, expects the demand for these drugs to increase significantly. “India has a very large diabetes and obesity burden, and with newer and potentially more affordable options entering the market, access is likely to expand beyond a small urban niche,” he says. Improving affordability is essential “if we want meaningful impact at a population level rather than limiting access to a small segment”, he adds.
Healthy awareness is key
So far, so good. However, most doctors stress that considering cost alone is hardly enough to prescribe semaglutides or GLP-1 therapies. “They are best suited for carefully chosen patients with type 2 diabetes, obesity, or obesity-related metabolic complications, after proper evaluation and counselling. With more options and improved affordability, their use is likely to increase-but treatment must remain strictly physician-guided and not trend-driven, as these drugs have potential side effects that require careful monitoring,” Dr Mittal clarifies.
Dr David Chandy, director of endocrinology and diabetology at Sir HN Reliance Hospital, says that while GLP-1 therapies are relevant in the current context of India’s health standards, “they are still far from mainstream.” Uptake is growing, especially after newer launches, but access, cost, awareness, and appropriate patient selection remain major barriers, he adds.
A recent Kantar report indicated that while urban India carries a large burden of overweight, obesity, diabetes, and prediabetes patients, awareness of GLP-1 therapies was only about 4.99% in urban Indians, owing to several factors, chief among them being treatment literacy and high costs impacting affordability and accessibility. Dr Chandy supposes that this is indicative of a larger problem. “Disease burden is expanding faster than treatment literacy. Public conversation often focuses either on “sugar control” or cosmetic weight loss, while the idea of obesity as a chronic metabolic disease is still under-recognised,” he explains.
According to Dr Abdul Rahman S, internal medicine and diabetology, Meridian Hospital in Chennai, “GLP-1 therapy prevalence is low but growing rapidly, and with more awareness programs it should become part and parcel of diabetes management soon.”
“Many patients are still only aware of traditional oral medicines or insulin. Awareness about newer metabolic therapies like GLP-1 receptor agonists remains low, both among patients and sometimes even among primary care providers,” adds Dr Jhingan of BLK-MAX, Super Speciality Hospital. “Apprehension about side effects is an additional factor,” he says. As per Dr Mittal of Sir Ganga Ram Hospital, the first step in spreading accurate and ‘healthy’ awareness is “to move the conversation from “sugar problem” or “just weight gain” to “metabolic health”.
He says it should focus on three main messages — prediabetes and central obesity are not harmless, screening should begin earlier in at-risk individuals (those with family history, abdominal obesity, fatty liver, PCOS, gestational diabetes history, or sedentary urban lifestyles), and treatment should be explained as a spectrum including diet, activity, sleep patterns, behaviour change, prescribed medications, bariatric or metabolic surgery, etc.
Dr Jhingan adds that awareness can be strengthened “through public health campaigns, school-based education, workplace wellness initiatives, routine screening programs and responsible media engagement.” He adds, “Most importantly, people must understand that metabolic diseases are largely preventable with early lifestyle changes and timely medical intervention.”
Dr Chandy further stresses, “Newer therapies such as GLP-1 drugs are prescription tools for selected patients-not universal solutions. This is especially relevant as Indian regulators have just cautioned companies against direct or surrogate public advertising of prescription weight-loss drugs.” He notes that awareness is imperative to ensure that patients and at-risk individuals are not misled about the need and effect of the drug.
The Central Drugs Standard Control Organisation has strict rules against carrying promotional activities for prescription drugs. “Drug companies can work in association with doctors and medical organisations to take up disease awareness initiatives in an effective manner. This is likely to help in overcoming the stigma surrounding the two diseases,” suggests Dr Bhattacharya.
“Public health campaigns that encourage screening, preventive care, and lifestyle management are another appropriate way to increase awareness while remaining compliant with regulatory standards,” adds Dr Jhingan of BLK-MAX Super Specialty Hospital.
Disclaimer: The information in this article is for educational and informational purposes only and is not intended as medical advice. While the author has incorporated expert medical guidance while producing the story and ensured full authentic information is provided to the reader, you should always seek the advice of a qualified healthcare provider regarding a medical condition or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here.