It has been nearly two weeks since the semaglutide patent expired, and India’s weight-loss drug market is already opening up to cheaper generics. For a country grappling with a rising obesity burden—driven by sedentary lifestyles, stress, and dietary shifts—this moment could mark a turning point.
The patent on the drug, held by insulin major Novo Nordisk, expired on March 20, 2026. The Danish company markets semaglutide for diabetes and obesity under the brand names Ozempic and Wegovy, respectively.
In India, the average cost of generic versions of Wegovy-- the most popular weight-loss injection-- stands at roughly a quarter of the original price. This is paving the way for wider access to this much sought-after anti-obesity medication in the domestic market.
Until now, access to these drugs was limited. The original semaglutide formulations sold by Novo Nordisk were widely regarded as effective, but their high cost meant many patients who needed them simply could not afford them. With Indian generic manufacturers and marketers now stepping in, prices have dropped, making these treatments far more accessible.
According to reports, one months treatment of Wegovi costed Rs 10,850 to Rs 17,345 in India as of early 2026. While, Dr Reddy's Laboratories has launched its semaglutide injection, Obeda, at Rs 4200 for a month's dose, and Sun Pharma and Zydus Lifesciences have launched their brands at around Rs 3600 and Rs 2200 respectively for a month. These Indian companies launched semaglutide generics on the same day of Novo Nordisk's patent expiry.
But this wider access to the drug is not without consequences. And the biggest concern is not the drug itself, but how it will be used.
While talking to The New Indian Express, Dr Naval Vikram, Physician, Diabetologist and Professor in the Department of Medicine at AIIMS-Delhi, and Dr Preethi Mrinalini K, General and Laparoscopic Surgeon at Apollo First Med Hospitals, Chennai. expressed deep concerns about the likely misuse of the drug.
Rising misuse risks and concerns over the quality and consistency of cheaper generic weight-loss drugs
Similar to any commodity, which would attract more consumers when at a lower or discounted price, cheaper variants of weight loss drugs would allow more people to take it, even without a proper medical supervision.
Its easy availability and affordability would not make an individual think twice about getting lean and obesity free, but being lean doesn’t always mean being fit. So, cheaper drugs can become problematic when individuals who do not actually need them are tempted to try them. Experts say these drugs, which is to be strictly taken with medical advise and under supervision, should never be used for cosmetic purposes.
"Cheaper prices of these drugs could also make many complacent, pushing physical fitness and active lifestyles to the back seat. After all, who doesn’t love an easy solution?" they ask.
“... these drugs should not be abused. There have been cases where people walk into a pharmacy and ask for these drugs, and they are given to them as casually as they would be given a Dolo 650 or paracetamol. That should be stopped here,” says Dr Preethi.
Dr Naval agrees. “The risk of misuse increases especially when these drugs are promoted as blockbuster weight-loss solutions. People looking for quick results may use them temporarily and then discontinue, even if they were never medically indicated in the first place,” he says.
While this also raises questions about the quality of generic versions of these drugs, any potential differences in quality or efficacy must be carefully considered.
“There is the part of the rDNA technology and other scientific processes that are involved in the original production of the drugs. But, when we talk about generic drugs, they are not necessarily produced in the same manner as the original drug,” explains Dr Preethi.
Safeguards needed before wider access to weight-loss drugs
There are certain safeguards that should be in place before these drugs become widely available. They should strictly be prescription-based, and only doctors specialised in this area of treatment should be allowed to prescribe these drugs, to cut down on the misuse or abuse of these drugs.
According to Dr Naval, the quality of these drugs entering the market must be reliable and comparable to the original. If a drug is cheaper but not as effective, then there is little value in having it.
“… the government of India has introduced curbs stating that only specific specialists—such as endocrinologists and MD medicine physicians—should prescribe these drugs. These are the professionals who primarily manage obesity and diabetes and are best equipped to understand how these medications work, as well as their potential risks. Restricting prescriptions to these categories is a welcome move, as it ensures that not just anyone can prescribe them,” he explains.
Therefore, he adds, “the responsibility also lies heavily with physicians. They must exercise careful judgment in deciding when these drugs are appropriate, where they can be used, and where they should be avoided.”
So, ultimately, while patients may request these medications, it is the physician’s responsibility to determine whether they are indicated, necessary, or contraindicated in each case.
Why bioequivalence is critical for these drugs
Many of the companies entering this space and planning to launch these products, are well reputed. However, there is no direct head-to-head comparison of the bioequivalence of these so-called generic semaglutide drugs.
That said, one would expect these companies to follow strict good manufacturing practices and rigorous evaluation processes to ensure that the final product they manufacture and sell matches the reference drug in quality, efficacy, and bioavailability.
What is ideal according to Dr Naval is that this should be ensured before manufacturing licenses are granted, and it is likely that these companies adhere to such standards.
“We therefore assume that these products would demonstrate bioequivalence comparable to the international reference drug, which is particularly important because these are peptide-based medications,” he says, adding that manufacturing, storage, transport, and use of peptides require stringent quality controls, such as maintaining a proper cold chain, to preserve their bioavailability and efficacy.
Hence, it is expected that all companies entering the market will comply with these critical quality measures.
Bypassing supervision, patient selection, and the challenge of monitoring patients
Patients bypassing medical supervision is more common than it should be. These are prescription drugs, and that’s something that needs to be taken seriously.
“There should be stricter regulations by the government. We are also seeing doctors from other specialities prescribing these drugs. Obesity is a complex disease, and it’s not just taking a pill and considering the job done. It’s a more complicated process,” Dr Preethi says.
It is clear that this is a prescription drug and should only be prescribed by qualified specialists, not just any doctor. But, what kind of patients should not be using these drugs?
“Patients who are not within the overweight or obese category,” Dr Preethi says.
She adds, “We are seeing patients with a BMI even as high as 24, wanting to lose 4 or 5 kilos for cosmetic reasons, and wanting to be put on these medications. It is these patients that I think are the biggest concern, and that is where the potential for abuse is the greatest. It is not just one doctor saying no; it should be a collective no.”
The next category of patients that should not be on these medications, according to her, are those that are planning to get pregnant. These medications are contraindicated in pregnancy and also while breastfeeding.
“There are also patients with MEN syndrome, and these patients should not be on these medications. There are patients for whom these medications are absolutely wrong, and that is where we need to draw a line and be strict about it,” she adds.
Interestingly, according to Dr Naval, individuals with a history of thyroid cancer, pancreatic disease, or pancreatitis, and those who do not actually need them should not use them.
For instance, someone who is not significantly obese and is trying to bypass diet and lifestyle changes by relying solely on the drug should not be using it.
Diet and lifestyle remain the most important components of weight management. “Drugs can have adverse effects. Additionally, they should be avoided in women who are planning pregnancy, as there is insufficient safety data regarding their use during pregnancy. Women trying to lose weight before conception should not use these medications, and those who are already on them should avoid planning pregnancy until the drug has been discontinued,” he explains.
Moreover, patients should be monitored closely during the treatment. There should be a monthly review, usually done towards the end of their third dose or just before they complete the fourth dose, to start the next one.
There should be a detailed evaluation, which will help doctors decide whether the dosage must be increased or if it has to be continued at the same rate, along with the management of any side effects.
Side effects and long-term safety concerns of weight-loss drugs
The most common side effects include gastrointestinal side effects, considering that these medications directly influence the gastrointestinal system. This includes nausea, vomiting, constipation, and diarrhoea, accompanied by a certain amount of bloating. This is, however, quite common according to Dr Preethi.
These effects tend to disappear within a few weeks or after a few doses, considering that the body gradually gets accustomed to such effects.
Among the rare side effects, Dr Naval says, is pancreatitis. Though it is uncommon. “Another less frequent but important side effect is vision problems. Individuals taking these medications who experience any visual disturbances should immediately contact their healthcare provider or the prescribing physician and seek an evaluation from an ophthalmologist,” he says.
While the research on effects of long-term use, especially in otherwise healthy individuals, has been ongoing, the current standard protocol is to slowly wean patients off the drug once the desired weight has been obtained.
“Studies are currently being done to see if a smaller dose will help keep weight off and prevent a rebound effect,” Dr Preethi says.
Muscle loss and nutritional risks with rapid weight loss
For those who think weight loss drugs help with losing fat alone, it is not true. It definitely results in muscle loss.
Dr Naval explains this with an example.
“If someone loses 10 kg, roughly 8 kg may be fat while about 2 kg could be muscle. In general, around 20–25% of the weight lost can be lean mass, which includes muscle, and this is a concern because muscle loss is not desirable,” he explains.
Another issue, he highlights, is the risk of nutritional deficiencies with weight loss. These drugs do not cause weight loss as quick as surgery, but they are faster than lifestyle changes alone.
“Since they suppress appetite, individuals may end up eating less, and if the diet is not balanced in terms of macro- and micronutrients, deficiencies can occur,” he says.
This is why careful monitoring is important. The diet should remain well-balanced, with particular emphasis on adequate protein intake to help preserve muscle mass. In addition, incorporating resistance or muscle-strengthening exercises is essential. A combination of a high-protein diet and regular resistance training can significantly help offset muscle loss.
Should weight-loss drugs be reserved for when lifestyle changes fail?
Dr Preethi is clear. She says that without any change in our lifestyle, without any change in our dietary habits, without any change in our level of activity, it does not make sense to use these medications on our own. The weight will return when the drug is discontinued.
Dr Naval concurs, “Lifestyle interventions are absolutely the first and most important step in managing weight.”
However, in individuals with a high BMI, medications may be considered. “Internationally, obesity is defined as a BMI over 30, whereas in the Indian context, it is lower—generally above 25. In practice, individuals with a BMI above 27 in India, along with comorbidities such as diabetes or hypertension, may be considered for these medications,” Dr Naval says.
While drug regulators and manufacturers are responsible for ensuring safety and putting safeguards in place to prevent misuse, neither responded to TNIE’s queries on their preparedness to ensure quality, robust supply chain measures, and ethical use.