When cheaper generic versions of semaglutide – originally developed by Danish drugmaker Novo Nordisk and runaway success under the brand names Ozempic and Wegovy globally – hit the Indian market this March, its rival Mounjaro’s extraordinary run in the country faced its biggest test.

Why would patients continue paying over Rs 13,000 to Rs 26,000 for a premium obesity drug when versions of a rival GLP-1 medicine were suddenly available at a fraction of the cost?

For a brief period, the answer seemed obvious.

Mounjaro’s monthly sales came under pressure as generic semaglutide entered the market, while cheaper versions rapidly brought in patients who had earlier been priced out of GLP-1-based therapies, the drugs initially developed for type 2 diabetes that have become blockbusters as they remarkably bring down weight by reducing appetite and slowing digestion.

Six months later, however, the market has produced a more surprising outcome: generic semaglutide, which brought its price as low as Rs 1290 per month, did not kill Mounjaro.

Instead, it appears to have expanded India’s anti-obesity drug market while Mounjaro retained its hold over the premium segment.

According to PharmaTrac’s August 2026 data, tirzepatide accounted for 72% of the GLP-1 agonist market by value, generating Rs 1,456 crore in sales till August. Injectable semaglutide accounted for 23%, or Rs 459 crore. The overall GLP-1 agonist market is now valued at Rs 2,333 crore.

Mounjaro by US-based pharma giant Eli Lilly, which contains tirzepatide, has remained India’s number one drug brand since October 2025.

The generic wave, rather than simply replacing one medicine with another, appears to have drawn a new layer of patients into the market.

NEW DIMENSION

The biggest impact of cheaper semaglutide has been on access – and on where GLP-1 drugs are being sold.

Before generics arrived, the market was largely concentrated among affluent patients in India’s largest cities.

Sheetal Sapale, vice-president at PharmaTrac told India Today, the launch of lower-priced versions changed that pattern.

“Initially, when only the innovators were there in the market, sales were concentrated in the metros. As the generics were launched, sales also started happening in cities beyond the big ones,” she said.

The increase was not merely a shift of patients from Mounjaro to semaglutide. PharmaTrac data suggests that monthly GLP-1 sales rose from around 20,000 units before generic semaglutide to about 60,000 units after its launch.

“These were patients who were eligible but could not afford the products earlier. Now, a majority of them have got on board,” Sapale said.

The market has since stabilised after the initial surge, suggesting that the first wave of lower prices quickly brought in patients who had been waiting for a more affordable option.

The geographic shift has been particularly visible in smaller towns, where more than 90% of GLP-1 sales are estimated to be generic products.

Ahmedabad and Hyderabad, both relatively price-sensitive markets for instance, have also seen a significant pickup since generics arrived, with generics accounting for nearly 90% of units sold.

Yet wider availability has not turned GLP-1 therapy into a mass-market treatment. Volumes outside the metros remain much smaller, pointing to barriers that go well beyond the price of the drug.

WHY MOUNJARO ENDURED

Mounjaro’s resilience comes down to a combination of clinical positioning, brand familiarity and the way patients are moving through treatment.

Tirzepatide was launched in India in March 2025, giving Mounjaro a head start before injectable semaglutide first as Wegovy and later also as Ozempic, arrived.

In March-April this year, once the patent on semaglutide in India expired, over 40 diffrent brands of its generic versions hit the market.

But even before all that had happened, Mounjaro seems to have already built awareness among doctors and patients.

Tirzepatide is also a dual GIP and GLP-1 receptor agonist, while semaglutide works through the GLP-1 pathway. Doctors say the choice is increasingly being shaped by what a particular patient needs rather than price alone.

“The choice is increasingly not simply about which drug is better, but about which treatment is best suited to the individual patient,” said Dr Subhash Wangoo, senior endocrinologist at Apollo Indraprastha Hospital in the capital.

In his practice, Dr Wangoo said he is more likely to consider tirzepatide when substantial weight loss is an important treatment goal, particularly in patients with obesity, prediabetes or multiple adiposity-related metabolic complications.

“The goal is not simply to see the number on the weighing scale come down. It is about reducing adiposity and, more importantly, preventing or improving adiposity-based chronic disease,” he said.

That can include diabetes, cardiovascular disease and metabolic dysfunction-associated steatotic liver disease.

The magnitude of weight loss associated with tirzepatide has also strengthened Mounjaro’s appeal. Dr Wangoo said weight reduction can reach up to around 25% with tirzepatide, compared with about 20% with semaglutide, depending on the patient and treatment setting.

Mumbai-based diabetologist and metabolic disease specialist Dr Rajiv Kovil said patients are increasingly focused on outcomes.

“Tirzepatide, particularly Mounjaro, continues to see strong demand primarily because of the magnitude of weight loss it can deliver,” he said. “Many are willing to pay a premium if they perceive that the therapy can help them achieve greater and faster weight loss.”

PharmaTrac data also offers a clue to why Mounjaro’s value continues to rise even as unit growth has moderated. Patients who began treatment on lower initiation doses are gradually moving to higher, more expensive strengths.

The drug’s early single-dose vial strategy may have also helped bring patients into treatment, allowing them to try the medicine without committing upfront to a larger multi-dose pack. As patients continued and moved up the dosing ladder, the value of sales increased.

TOO MANY OPTIONS, TOO MUCH CONFUSION?

Generic semaglutide has undoubtedly pushed the GLP-1 market beyond India’s biggest cities. The question is whether that expansion can be sustained.

For Dr Wangoo, one of the biggest obstacles is the way obesity itself continues to be viewed.

“Obesity is often still perceived as a matter of lifestyle, willpower or appearance rather than a chronic, relapsing metabolic disease that requires long-term management,” he said.

In routine primary care, controlling blood sugar, blood pressure and other established complications often takes priority, while weight management can remain secondary.

Affordability, even after generic entries, is another limitation.

Obesity treatment is rarely a short-term intervention and can require months or years of medication, follow-up and lifestyle support. A lower-priced GLP-1 medicine may still represent a significant recurring expense for households outside higher-income groups.

Dr Kovil believes demand itself is spreading beyond metropolitan India.

“Patients beyond metros are equally conscious about obesity and increasingly aspire to achieve meaningful weight reduction,” he said.

What has not expanded at the same pace is the medical ecosystem needed to support treatment.

GLP-1 therapy involves patient selection, assessment of obesity-related complications, dose titration, management of adverse effects and counselling. Smaller cities have fewer endocrinologists, obesity specialists and trained dietitians to provide this structured follow-up.

Dr Kovil also points to the growing complexity of the market itself.

“We now have multiple formulations and delivery systems – disposable pens, reusable devices and pre-filled syringes – along with differences in dose escalation and titration across products,” he said.

Even doctors may not have hands-on familiarity with every device and formulation. As more products enter the market, physician and patient education could become as important to penetration as pricing.

The country’s large burden of obesity and diabetes, meanwhile, does not mean every patient is a candidate for these drugs. Some may not tolerate side effects, while others may have medical reasons requiring caution. Diet, physical activity and other interventions also remain central to obesity management.

ORAL GLP-1s LAG

The relatively slow uptake of oral GLP-1 drugs is another feature of India’s evolving market.

Tablets should, in theory, have an advantage over injections. But oral semaglutide and newer oral GLP-1 options currently occupy an awkward middle ground.

Traditional diabetes medicines remain inexpensive, familiar and widely available, with many generic formulations costing roughly Rs 50-Rs 300 a month. Oral GLP-1 therapies can cost approximately Rs 2,500-Rs 4,000 or more.

At the same time, patients seeking significant weight loss can compare a daily oral medicine with a weekly injectable that may offer greater weight reduction. Dr Wangoo estimates weight loss with oral GLP-1 therapy at around 10%-15%, compared with the higher outcomes associated with newer injectable therapies.

“For many patients, particularly those already comfortable with GLP-1 injections, the injectable may simply make more sense from a cost-benefit and convenience perspective,” he said.

Dr Kovil believes that could change as newer oral medicines arrive.

“India has not rejected oral GLP-1 therapy – we are simply waiting for the oral GLP-1 that delivers the right combination of efficacy, convenience, tolerability and affordability,” he said.

Market analysts, meanwhile, sum it up this way: India’s GLP-1 market is expanding along two tracks – generic semaglutide is widening access and pushing treatment into new cities and patient groups and Mounjaro continues to dominate a premium segment where clinical outcomes, brand familiarity and the willingness to pay remain powerful drivers.

– Ends

Published On:

Sep 11, 2026 14:08 IST