Eli Lilly's India market share falls as generic semaglutide takes hold

Eli Lilly's grip on India's GLP-1 weight-loss market loosened in March, when its share of the category slid to 56% from 61% a month earlier, according to Pharmarack data cited by CNBC. Novo Nordisk finished the month at 25%, the same level it held in February ^[1].

The change followed the expiration of India's semaglutide patent, which set off a rush of cut-price copies. The Pharmarack report found that 13 Indian manufacturers had introduced 26 semaglutide brands within weeks of one another ^[1]. Semaglutide is the molecule in Novo Nordisk's Ozempic and Wegovy; Lilly's competing therapy is tirzepatide, sold in India as Mounjaro ^[1]. The new generics were expected to hurt Novo Nordisk, whose brands are the original semaglutide products, but early data show Lilly absorbing the bigger blow ^[1].

A fast-moving price war

The cost gap between the two molecules is now wide. Mounjaro begins at roughly 13,800 rupees, about $148, for a month's supply, Mumbai diabetologist Rajiv Kovil said. That is more than twice the price of Novo's semaglutide medicines and roughly ten times the cheapest generic alternatives ^[1].

Novo Nordisk moved to defend its position, announcing March 31 that it would cut Ozempic's price by 38% and Wegovy's by 48%. Vikrant Shrotriya, managing director of Novo Nordisk India, said the goal was to keep the treatments within reach of as many people in the country with type 2 diabetes, overweight or obesity as possible ^[1].

After those cuts, Novo's semaglutide products start at 5,660 rupees a month, against about 4,200 rupees for the pricier generics, according to Anant Kharad, who leads pharmaceutical practice at Anand Rathi Investment Banking. Some copies sell for as little as 1,290 rupees a month, he said ^[1].

Pharmarack's numbers suggest the cheaper semaglutide has pulled patients away from Lilly rather than from Novo. Vishal Manchanda, a pharma analyst at the Indian brokerage Systematix Group, tied the erosion to the widening price gap between the two drugs and to the attention the new generics have drawn. Over time, he said, tirzepatide could become a product for patients who can afford it and who are focused chiefly on losing weight, since it remains more effective but costs more ^[1].

Lilly may face more pressure: as semaglutide gets cheaper, sales of its tirzepatide brands are likely to erode further, experts said ^[1]. Kovil said the pull toward cheaper options is strongest among people seeking fast results, including those trying to lose weight before events such as weddings ^[1].

India's market is large and growing. Roughly 100 million people there live with diabetes, and close to a quarter of the population is classified as overweight or obese, according to the report. The country's generic industry supplies about 20% of the world's generic medicines ^[1]. Analysts estimate the Indian GLP-1 market will expand almost five-fold to 50 billion rupees by 2030, with some bullish projections above $1.2 billion, helped by rising rates of obesity and diabetes and by the arrival of low-cost copies ^[1].

Why it matters for patients

None of this changes what Americans pay or what their insurers cover. Whether generic semaglutide will be sold in the United States, and when, has not been reported ^[1].

Still, India offers a preview of how quickly a market can be reshaped once a cheap version of the same molecule appears. Novo Nordisk cut its own prices by roughly a third to a half in a single announcement ^[1], and Lilly gave up five percentage points of share in one month ^[1].

The Indian experience also shows two forces pulling in opposite directions. Manchanda expects the more effective but costlier drug to become a premium option while cheaper semaglutide serves the wider market ^[1]. Kharad's view is that price alone may not settle the question; over the next 12 to 18 months, the deciding factor will be whether doctors trust the quality of the copies ^[1].

One caveat: the figures reported are shares of the market, not sales totals. The report does not give overall volumes for either company, so whether Lilly's Indian sales rose or fell in March is not established ^[1].

What happens next

More Indian manufacturers are still waiting for regulatory clearance to launch GLP-1 products, and analysts expect demand to end up concentrated among four or five companies ^[1]. Kharad named Sun Pharmaceutical Industries, Torrent Pharmaceuticals, Dr. Reddy's Laboratories and Zydus Lifesciences as among those best placed to capture the market ^[1].

The base projection cited in the report puts the Indian GLP-1 market at 50 billion rupees by 2030 ^[1]. March was the month measured in the new Pharmarack figures; share data for later months has not been reported ^[1].