With nearly 50 brands of generic semaglutide set to launch in the Indian market on Saturday, doctors applaud the reduced cost and increased availability of the drug for their patients, along with a word of warning — it is not meant for all, it should not be misused to lose those last five kilos. Doctors describe this as a “unique situation” whereby so many brands of the same medicine are set to be launched on the same day.

There is likely to be a significant drop in the prices. Take for example Natco Pharmaceutical that will launch ‘Semanat’ and ‘Semafull’ in 2 mg, 4 mg and 8 mg doses. The drug will cost Rs 1,290 per month for the lowest dose and Rs 1,750 for the highest one, according to the company. It will also launch an easy-to-inject pen device next month in the same three doses that will cost Rs 4,000, Rs 4,200, and Rs 4,500 respectively. To compare, innovator drug major Novo Nordisk’s Ozempic meant for the treatment of diabetes costs between Rs 8,800 and Rs 11,175 per month while its weight-loss Wegovy costs between Rs 10,850 to Rs 16,400 per month

The Indian Express speaks to top diabetologists to ask whether they would prescribe these medicines and what are their concerns.

Would you prescribe generic medicines?

Dr Jothydev Kesavadev, chairman of Dr Jothydev’s Diabetes Research Centre, Kochi, says the generics may not intrude into the space of the original brands already available in the market.  “Some patients are cost-sensitive and some are brand-sensitive. Those brand-sensitive will not want to compromise on the innovator drug. On the other hand, there will be cost-sensitive patients for whom the price point of generics will be attractive. So, we have to give them the choice. However, even among the generics, there is a lot of choice, so we will see prescription-based responses. Within three of four months all the brands other than the top five or six are likely to vanish.”

Dr V Mohan, Chairman of Dr Mohan’s Diabetes Specialities Centre in Chennai, feels since the drug has been a game-changer in terms of diabetes control, obesity, weight-reduction, fatty liver, obstructive sleep apnea, and joint problems among others, generics would open access to drugs that can help reduce the burden of chronic diseases.

Since generic drugs will result in a drastic price reduction, he feels “semaglutide will be available to people, who would otherwise have been denied the opportunity for using this drug.”

Do you have any concerns with generics?

Quality is definitely an issue with multiple players. As Dr Mohan says, “When you have so many companies producing the molecule through different methods, logic dictates that all of them are unlikely to be of the same quality. The process is also such that in some cases there is a possibility of impurities. So, we have to look for options which have minimal impurities and result in minimal side effects. Therefore, it’s best to stick to companies that have a history of producing high quality drugs.”

However, he doesn’t rule out the potential of a wider reach for generics. “India is the pharmacy of the world and is a pioneer when it comes to generics. Indian generics are marketed to the US and the world. Take for example, the common diabetes medicine metformin. Nearly 50% of its generics in the US goes from India. So, there is great potential for use of this drug not only in India but also other countries in Asia, Africa and so on.”

Dr Jothydev has an added concern of cold chain maintenance considering that these are injectables. “Temperature control is necessary for transport and storage, something many of the pharma companies making these drugs do not have experience with. This is something to be considered when we talk of generics.” At home, it needs to be stored on the door of the refrigerator, just like one would insulin, he says.

What are advisories against use or misuse?

Dr Mohan cautions against the misuse and overuse of the drug. “This should not open the flood-gates for everyone who has a little additional weight. These are very powerful drugs that act on the brain and the stomach. Side-effects, while mild in most cases, can also sometimes be severe like pancreatitis, thyroid cancer, paralysis of the stomach, and even blindness in a few cases.”

He has already come across reports of semaglutide being prescribed by non-physicians such as gym instructors and dieticians. Says he: “The use of semaglutide should strictly be limited to physicians, especially endocrinologists. It must be ensured that the drug is dispensed only with a prescription and must not be used in weight loss programmes by non-physicians. It should not be available over-the-counter or on online pharmacies.”