Race For Blockbuster Weight-Loss Drugs Pushes Indians To Gray Market

Stashing boxes of injectables in their carry-on luggage. Buying counterfeit formulas online. Importing boxes from Europe. The race to score blockbuster weight-loss drugs is pushing one of the world's largest populations of obese people to creative lengths.

Breathless media coverage has helped create a frenzy over the treatments. Such is the interest that the anti-obesity medication market could reach $100 billion by 2030, Goldman Sachs Research said. Indians, meanwhile, have simply been watching this from the sidelines.

That's because the latest formulations, Novo Nordisk A/S's Ozempic and Wegovy and Eli Lilly & Co's Mounjaro and Zepbound, won't be available in India anytime soon, amid global supply shortages.

For some buyers, that's not soon enough. They're turning to the flourishing gray market, where sales of imported bulk packs and alternative medications highlight the scale of pent-up demand and raise tricky questions about potential health risks.

In her upmarket New Delhi cosmetology and metabolic treatment clinic, Instagram-famous Dr Anjali Hooda sees celebrities, wealthy locals and expatriates, as well as Indians visiting home from abroad, who are trying to get their hands on weight-loss drugs.

Women, largely between their 20s and early 50s, come seeking prescriptions, Dr Hooda said. While many are obese, some have only small amounts of weight to lose.

Hundreds of patients have sought prescriptions from her in the past six months, she said. She recently denied an Ozempic prescription to a young patient who wanted to lose quick 4 kilograms (9 lbs) and already had doses of the drug from an unknown source.

"I told her she did not meet the criteria for the use and asked her to try it only at her own risk," Dr Hooda said.

In late 2017, Novo launched Ozempic-the GLP-1 drug that, while technically for diabetes, put weight-loss shots into the cultural consciousness. Then it rolled out Wegovy, which treats obesity. The two have raked in tens of billions of dollars in revenue for the Danish drugmaker so far. Eli Lilly started selling Zepbound in December last year - a weight-loss shot that's predicted to become the bestselling drug in history.

The obesity drugs are now a global phenomenon and often in short supply. They've won over the rich and famous and blown open a new market for weight loss drugs.

Novo Nordisk has "no plans" to launch Ozempic in India but is working to make Wegovy available, a spokesperson said in an email. Eli Lilly did not respond to an email seeking comment.

In India, the only drug available is Novo Nordisk's Rybelsus pill, which contains the same ingredients as Wegovy and Ozempic but comes in pill form. It was launched in 2022 but is considered less effective than the blockbuster injectibles.

India had the third largest number of people with obesity as of 2022, behind China and the US, according to a study in The Lancet, with numbers surging as junk food consumption becomes more commonplace. The country has about 80 million obese and 225 million overweight people, market research firm IMARC Group estimates.

A study of more than 100,000 Indians aged over 20 found more than 11% of people were diabetic, with a further 15% pre-diabetic. Meanwhile, chronic kidney disease has been ranked as the eighth-highest cause of death.

"It is not easy to procure them," Dr Kiran Kaur Sethi, the celebrity skin doctor who runs New Delhi's Isya Aesthetics, said of the drugs. "Many of my patients get it from their overseas channels."

For those with prescriptions, pharmaceutical distributors can import injectables from places including Europe, in an expensive process that has been typically used for oncology drugs.

Indian distributor Ikris Pharma Network Pvt. ships the drugs from warehouses in Belgium, Bulgaria and Hong Kong, said director Bharat Sikri, in a process that can take around 10 days. Costs can fluctuate but it's around $1,200 for a monthly supply of the drugs, after the patient pays for cold storage, shipping, customs and tax, he said.

"Most of the patients we see are unaware of the process and come without prescriptions," Sikri said.

"They often end up going to illegitimate pharmacies who sell medicines that may be counterfeit."

India's gray market offers alternatives, including chemists and drug importers advertising weight-loss injectables on platforms like IndiaMart InterMesh Ltd. and ExportersIndia.com. IndiaMart did not respond to Bloomberg News queries.

A pack of Wegovy from these retailers can cost 9,500 rupees ($113) for a four-week supply, less than one-tenth of some US prices, while a four-week pack of Zepbound can cost about 7,800 rupees ($93), according to prices seen by Bloomberg News on ExportersIndia.com.

Some New Delhi and Mumbai-based chemists also bring treatments from countries like United Arab Emirates or Egypt, and sell bulk packs for cash, according to an investigation published in March by India Today.

Wegovy alternatives, like Bangladesh-based Incepta Pharmaceutical Ltd.'s Fitaro, not officially marketed in India, are also gaining popularity, as online retailers supply it to Indian buyers.

Central Drugs Standard Control Organization, India's top drug authority, did not respond to an emailed request for comment.

Novo Nordisk's Rybelsus pill costs about $43 for a 10-day supply. Sales of Rybelsus increased about 150% in the 12 months to April, from a year earlier, to 3.63 billion rupees, according to analytics platform Pharmarack.

The pill is one of the top products for Novo Nordisk in India, managing director for the country Vikrant Shrotriya told Bloomberg News. "India is a very critical market," he added.

Arjun Sha, a 30-year-old writer from West Bengal, shed about 24 kilograms in seven months of taking Rybelsus, before stopping the drug in February. Sha had been obese for more than a decade, he said, and decided to take the pills after being introduced to them by his doctor girlfriend.

Now, he said he's also stopped taking medication for high blood pressure and cholesterol, relying on exercise to continue to lose weight.

"There is generally a taboo around taking drugs in India," Mr Sha said. "I tell people online they could try this, after consulting a doctor, because this is really helpful."

Injectables are expected to be available in India from next year, when Eli Lilly plans to launch Mounjaro, Reuters reported. A deluge of generic weight-loss drugs are forecast to flow soon after when patents of semaglutide, used to make Novo's weight loss medicine, start to expire in 2026.

Locally, India's largest pharma firm Sun Pharmaceutical Industries Ltd. is developing its own weight-loss formulation, while Cipla Ltd. and Dr. Reddy's Laboratories Ltd. are working on generic drugs.

Biocon Ltd. and Glenmark Pharmaceuticals Ltd. are already banking on generic versions of an earlier generation of obesity treatments, a liraglutide injectable sold by Novo Nordisk as Saxenda.

Dr Ramen Goel, director at Mumbai's weight loss-focused Centre of Bariatric Surgery, said more than half of the dozen or so patients he sees daily ask about obesity drugs. The treatments are a good solution for Indians who can afford them, Dr Goel added.

"People are fully aware of what is happening internationally," said Dr Goel, who has worked on obesity-related ailments for 24 years. "There is a lot of excitement."