By now, Ozempic needs no introduction in America. One in 8 American adults now takes a GLP-1 drug of some kind. But even as millions of people in wealthy countries have benefitted from these drugs, they have remained out of reach for most of the world.

But for a country of 1.4 billion people, this medication just got a lot more accessible.

Last month, a key patent on semaglutide — the GLP-1 sold as Ozempic, Wegovy, and Rybelsus — expired in India, a country known for making affordable drugs at scale. Within days, at least a half-dozen Indian drugmakers had launched generic semaglutide, with more than 40 expected to follow. The cheapest version costs about $14 a month. The same drug goes for as much as $349 a month in the US without insurance (where patents don’t expire until 2032).

GLP-1s are often talked about as weight-loss drugs. But semaglutide’s bigger significance may be that it can treat a cluster of related metabolic diseases — especially obesity, diabetes, and cardiovascular risk — all at once.

That matters a lot in India. The country has one of the largest diabetic populations in the world by sheer number — more than 100 million people are estimated to be living with some form of the disease. And 350 million people there live with obesity. Heart attacks and strokes, which are lumped together under cardiovascular disease, claim 2.8 million lives a year in India, and strike nearly a decade earlier on average than in high-income countries.

Those numbers have been climbing “linearly upwards” for decades, said R.M. Anjana, a researcher-physician at the Madras Diabetes Research Foundation in Chennai who has also co-authored India’s largest national diabetes studies. And until now, no drug or policy has made much of a dent in the national numbers.

But there are early signs that GLP-1s can make a difference at the population level. In the US, adult obesity — which had only gone up since Gallup first started measuring it in 2008 — fell by nearly 3 percent between 2022 and 2025 as GLP-1 use surged. It was the first time anything in recent memory had bent that curve at a national scale.

India’s metabolic crisis is different, and much larger — which makes the moment all that much more consequential.

Two ways of seeing Ozempic

Diabetes and heart disease are often bound up with obesity in some form. And in India, there are millions who don’t have obesity by standard measures but already show signs of metabolic disease, such as high blood pressure or insulin resistance, putting them at greater risk of these diseases. Researchers have found that this group — people with lower weights who still have the metabolic issues common with obesity — is the single largest metabolic category among Indian adults, roughly 43 percent in a large national study. This is exactly the profile where semaglutide’s benefits will be the most dramatic.

“Should it be given to everyone? No, definitely not,” Anjana said. “But there’s definitely a group of people who’s going to benefit from these drugs, and making it more affordable is a good step.” Even those who develop Type 2 diabetes without obesity may see improvements on semaglutide.   

And how the drug is understood popularly matters, especially in the early days. In India, as in the US, much of the public excitement around it has centered on slimming down, with weight-loss clinics popping up around the country and marketing pushing the drug’s weight-loss potential ahead of its clinical use.

That framing isn’t entirely wrong. India does have a substantial obesity burden, and reducing excess weight can have real benefits in also reducing other diseases. But this focus on one usage of the drug has created a strange distortion. Some diabetes patients who might have improved health outcomes with the drug are wary of it because they think it’s primarily cosmetic. Others, as Ambrish Mithal, an endocrinologist at Max Healthcare in New Delhi, puts it, “just want to lose three kilograms for a daughter’s wedding.”

“It’s the excitement of treating disease that is driving the doctors. It’s the excitement to lose weight that’s driving the public,” he said. “They’re looking at two different things.” In terms of tackling a massive disease burden, the ends may well be worth the different paths to get there.

In the real world

There are early signs that these drugs are already shaping public health writ large, not just individual health outcomes, such as the recent decline in national obesity rates in the US. And last week, the UK expanded semaglutide availability for roughly 1.2 million people to help prevent further heart attacks and strokes.

Both of these developments are signals of a drug’s broader public health utility. In India, where the burden of these diseases is far higher, and the price of the drugs that treat them is getting so much cheaper, they could have an even bigger public health impact.

That broader medical case is part of the reason why the World Health Organization added GLP-1 drugs to its essential medicines list last September, a model list of medicines it recommends countries make widely available through their health systems. 

For now, though, semaglutide in India is available only through private doctors and pharmacies, not through government-funded care. In many countries, that would be a major barrier. It matters less in India, though, because most diabetes care already happens through private providers: about 80 percent of diabetes care is delivered that way, often paid out of pocket.

That also makes price especially important. Brand-name Ozempic and Wegovy previously cost more than $100 a month in India, putting them well out of reach for most people. In a country where the average monthly spending is between $44 and $75 a month per person, depending on where you live, that price was simply too high. Generics come in at a fraction of that price, which is, Anjana said, “a genuine boon.”

The entry of generics has also shaken the market. Recently, Novo Nordisk slashed the price of its branded Ozempic and Wegovy in India by up to 48 percent. With potentially more than 40 manufacturers soon to be competing in the marketplace, prices may fall further still, said Andrew Hill, a pharmacologist at the University of Liverpool who studies drug pricing. His latest estimate suggests that injectable semaglutide can be made for as little as $28 per person per year, leaving room for prices to dive even more.

Now for the hard part

Even at $14 a month, there are millions of Indians who can’t afford to pay out of pocket, and they’ll have to rely on the public health care system. But there’s no sign yet that the government will step in to help them. And recent experience doesn’t necessarily bode well. SGLT2 inhibitors, another class of diabetes drug, went generic in India six years ago and still haven’t made it to government clinics.

And India faces another, even more basic obstacle: diagnosis. According to the most recent round of India’s largest national health survey, one in four people with diabetes had not been diagnosed. A drug, however cheap, won’t help patients who don’t know they might need it. Still, for the hundreds of millions who do, or who will, the arrival of a $14 Ozempic will be transformative.

And India will not be the last place to test that promising development. Brazil and Canada, where patents are also expiring this year, are next in line. Plus, in roughly 150 countries, semaglutide was never patented in the first place. Together, those countries account for 69 percent of the world’s type 2 diabetics and 84 percent of people with clinical obesity.

But the stakes are arguably highest in India. Semaglutide can do something very few drugs can: lower weight, improve blood sugar, and reduce cardiovascular risk all at once. Now, for the first time, it is becoming genuinely cheap in a hugely populous country where all three conditions are widespread and rising. If it makes a dent there, it could point to one of the biggest public health breakthroughs of this generation.

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