As the Ozempic patent expires in India, who will be the biggest loser?

To say that yoursquore on Ozempic had become a bit of a flex as was the ldquoOzempic facerdquo mdash markers of the fact that one could shell out Rs 24000 a month to access the weight loss drug once only available abroad But with Novo Nordiskrsquos patent on semaglutide mdash the active ingredient in Ozempic or Mounjarolike drugs mdash expiring in India on March 20 dozens of generic versions are now set to flood the market at a fraction of the costWhile making a lifesaving drug like semaglutide more affordable feels like a win for equitable healthcare it has also raised questions over the manufacturing quality of the drug and another equally important aspect mdash storagePiciStockThere is no doubt that the drug is lifesaving for those whose bodies are being ravaged by obesity and diabetes but we also have to consider the potential for misuse According to a Lancet study published in August 2025 India has the secondlargest population of overweight and obese adults in the world 18 crore surpassed only by China 40 croreThe bigger concern though is the temptation the drug poses to those who see it as a shortcut to feed their obsession with being skinny or as a way to tackle their body dysmorphiaSelfadministration is huge concern in the medical community Representational picGetty ImagesItrsquos a classic ldquotoo much of a good thingrdquo scenario Doctors now fear that there arenrsquot enough barriers to prevent abuse of the drug without medical supervision In a statement on March 24 the Ministry of Health and Family Welfare announced that the drug can only be prescribed by an endocrinologist an internal medicine specialist and for some indications by cardiologists In the same statement the ministry too warned of misuse It stated ldquoWith the recent introduction of multiple generic variants of GLP1based weight loss drugs such as semaglutide in the Indian market concerns have emerged regarding their ondemand availability through retail pharmacies online platforms wholesalers and wellness clinics These drugs when used without proper medical supervision may lead to serious adverse effects and related health risksrdquoWhile a prescription is mandatory there are concerns of loose oversight on the retail end of the chain which has been known to allow antibiotic and painkiller abuse in India Which basically translates to people having complete control over mdash or lack of it mdash on when and how much of the drugs to selfadministerRs 1200Average monthly cost of the generic versions of the drug18croreNo of obese people in India Lancet 2025The need of doctor interventionPatient A 57 Diabetic MaleldquoI was recommended to take a fiveinjection course of Mounjaro when I was hospitalised for spine surgery last year to drop blood sugar levels to make postop recovery smoother Irsquom diabetic but since my blood sugar readings were good the physician did not recommend a stronger doseI was discharged and started the injections on a weekly basis My average blood sugar reading had reduced from 68 to 61 which was quite remarkableHowever I endured aftereffects such as extreme weakness and constipation Now this need not be attributed to Mounjaro It could have been the medication given to me postsurgeryAmid my spine issue I was also suffering from a urinary tract infection When it got worse I visited a urologist who is a family friend of a close friend When I asked for his opinion on Mounjaro he swung his head side to side indicating lsquoNorsquoI stopped at four injections At the back of my mind I feel that maybe I should give it a shot mdash pun not intended mdash againrdquoTwo red flags No data collection no monitoringldquoRight now everyone is talking about Mounjaro or Wegovy another semaglutide injectable that delivers a higher dosage than Ozempicrdquo says Dr Sanjay Borude Dr Sanjay Borude Senior Consultant Bariatric Surgeon S L Raheja HospitalAfter the patent expiry doctors like Borude are seeing an influx of drugs that they can prescribe ldquoThere are 1920 companies that have jumped into the fray To the extent that the cost of semaglutidebased drugs which used to cost R17000 to 24000 per month has now dropped to merely R1200 per monthrdquohe addsMost of Dr Borudersquos patients though have erred on the side of caution ldquoPatients are doubting the quality they are asking lsquoHow can it be so cheaprsquo People are being cautious for nowrdquo he saysSanjay BorudeA problem he flags is data collection of patients on the drug mdash so far that was done by the doctor administering the treatment ldquoIf the chemist sells the drug directly to a customer then we will not have the data unless the patient comes back for followup Things like how many patients have continued the treatment for three months or more How many just stopped it because of the cost or side effects If the doctors donrsquot monitor people on this medication we will be clueless and then pharmaceutical companies can pretty much claim any kind of success raterdquo he addsWhen we ask if patients have reacted badly to the drug he responds ldquoYes many times things like indigestion bloating and nausea while a few are unhappy with the resutls and others about the high costrdquoHe also points out that many do not reveal they are on drugs from doctors when undergoing surgery ldquoIf a patient doesnrsquot disclose it to their anaesthesiologist there are critical complications that have happened Patients have vomited after being administered anaesthesia delaying the operation and some have even lost their livesrdquo he addsThe concern is that getting presription for the drugs wonrsquot be difficult anymore Representational piciStocklsquoCouldnrsquot take itrsquoPatient B 46 Borderline diabetic FemaleNeha Singh name changed a resident of Mumbai says she went off Mounjaro after three weeks because of the continuous and vicious cycle of diarrhoea vomiting and constipation ldquoIt was crazy I was puking having diarrhoea or I would be constipatedrdquo says Singh who started the drug in January on a prescription from her aestheticianldquoI was seeing so many of my friends including my aesthetician who were on the drug and benefiting from it To be honest I got a little FOMO fear of missing outrdquo she addsSingh has been trying to lose weight for the last five years with no success ldquoI tried Mounjaro but could only take it for three weeks By the fourth week I told my aesthetician about my bad reaction and she said lsquoIt doesnrsquot suit everyone so letrsquos take you off itrsquo I now feel I should have gone to an endocrinologist before taking itrdquo she saysldquoMany of my friends who are on it via an endocrinologist told me I went about it the wrong way so I actually get the fear people have right nowrdquo she adds ldquoIt took all of February to restore my gut health I might go to a proper doctor in a few monthsrdquo she says finallyItrsquos not for influencers to recommendDr Muffazal Lakdawala Director in General amp Minimal Access Surgery Sir HN Reliance Foundation HospitalMany doctors like Dr Muffazal Lakdawala are not handing out any prescriptions for the new drugs yet ldquoItrsquos too early to say as to which drug to prescribe and which not tordquo he saysldquoI just hope that the quality of all the generic drugs is very strictly regulated by the government so that we have no issue as to which drug is safe to prescribe Some of these drugs have to be maintained at a very clear profile in terms of the cold chainrdquo he addsDr Muffazal LakdawalaldquoThese are lifesaving drugsrdquo he asserts ldquoThis is probably the best chain of drugs we have had in 50 years to treat persistent diseases like obesity and type 2 diabetesrdquoldquoBut the big problem is the widespread social media messaging on the benefits of this drug Most social media influencers are giving their take on it despite not being doctors We need to bring in regulations like other countries such as China where you cannot give your opinion on a drug or even say something like lsquoit worked for mersquo unless you have the qualification to do sordquo he addsEven before the patent expiry doctors like him would get calls and messages from people who had started the drug without supervision ldquoWe have also had people who will say ldquoWe are getting this drug We just want to know what dose to takerdquo Without me knowing the patientrsquos history I have no way to know if they actually need it So I refuse and apologise to themrdquo he addsHow can selfadministration of the drug harm ldquoA patient might go straight to the 75 mg dose rather than start with 25 mg and ramp it up over four weeks That is why itrsquos vital that a medical practitioner oversees the prescription of these drugsrdquo he says ldquoWithout that you wonrsquot know the signs of complications like pancreatitis Or the early blindness that accompanied some cases of Ozempic usagerdquoIf someone can afford to buy GLP1 drugs they can afford to consult a doctor on usage too ldquoPeople must understand that by trying to save a little bit of money theyrsquore actually doing themselves much more harmrdquo he hopes