To The Moon

By Rishika Sadam

HYDERABAD, India, Dec 24 (Reuters) - Global pharma giants Eli Lilly LLY.N and Novo Nordisk NOVOb.CO are scrambling to cement their lead in India's booming obesity drug market before cheaper generic versions hit shelves in March next year.

Novo's strategy emphasizes price cuts and accelerated launches, while Lilly's products benefitted from hitting the market early. Both companies focused on aggressive outreach to doctors, heavier advertising about obesity, tie-ups with clinics, patient incentives and distribution deals with local drugmakers, according to doctors, analysts, medical representatives, patients and distributors who spoke to Reuters.

Lilly has even teamed up in India with well-known Bollywood actors in a social media ad campaign about obesity.

India, projected to have the world's second-largest overweight or obese population by 2050 in absolute numbers, is becoming a key battleground for obesity drugs. Analysts expect the global market for such drugs to hit $150 billion a year by the end of this decade.

Although the U.S. remains the largest market for obesity drugs, early sales figures in India show rapid uptake, even though most patients in the world's most populous nation pay for the medication out-of-pocket.

"We believe that this market can be more than $1 billion within two years," said Shrikant Akolkar, vice president at research firm Nuvama Institutional Equities.

Data analytics firm Pharmarack said in July that the market was estimated to be worth 6.28 billion rupees ($70.23 million) at present, growing fivefold since 2021.

U.S. drugmaker Lilly's Mounjaro, approved for diabetes and weight loss in India, became the top-selling therapy by value in October, with sales doubling within months of its March launch, outpacing Danish drugmaker Novo's Wegovy, which entered the Indian market in June.

"We realized just after a couple of months that for accessibility, we had to take a price cut," said Vikrant Shrotriya, Novo Nordisk's managing director in India, referring to Wegovy's price cut in November. Shrotriya spoke earlier this month while launching Novo Nordisk's blockbuster diabetes drug, Ozempic, in the country.

Ozempic, a once-weekly injection approved by the U.S. drug regulator in 2017 for Type 2 diabetes, became a global bestseller and is widely used off-label for weight loss due to its appetite-suppressing effects.

More than 20 Indian drugmakers, including Dr Reddy's REDY.NS, Cipla CIPL.NS, Sun Pharma SUN.NS, Zydus ZYDU.NS and Lupin LUPN.NS, plan to launch cheaper versions of Novo's weight-loss drug in India once its patent on semaglutide, the active ingredient in Wegovy and Ozempic, expires in March 2026.

Analysts expect generic drugs to cost about 60% less, intensifying the fight - particularly for Novo - for dominance in India's price-sensitive market.

Shrotriya played down concerns over looming patent expiries, telling Reuters that Novo will focus on quality, trust and affordability rather than on patents or competition in India.

LILLY'S GAIN IS NOVO'S PAIN

Lilly's Mounjaro has quickly gained traction in India. A 2.5 mg Mounjaro KwikPen costs about 13,125 rupees ($146.79) for a month's usage, with the highest 15 mg dose going up to 25,781 rupees ($288.33).

In response, Novo cut the price of Wegovy in India by up to 37% in November, pricing its lowest dose of 0.25 mg at 10,850 rupees ($121.34) for a one-month pack. It launched Ozempic last week for a monthly price of 8,800 rupees ($98.42) for 0.25 mg.

While Wegovy is catching up, Mounjaro's early launch helped it penetrate the market, and the latter drug's claim of offering greater weight loss makes it a popular choice among patients, said five doctors who spoke with Reuters.

"Mounjaro clearly has first-strike advantage and continues to have strong demand, but price-sensitive patients are reassessing alternatives," said Dr. Anoop Misra, an endocrinologist and executive chairman of Fortis C-DOC Hospital.

Mounjaro also differentiates itself by targeting people with severe obesity, said Vishal Manchanda, analyst at Systematix Institutional Equities. He added that Lilly faces no immediate pressure to cut prices, given its strong position.

Even if Lilly lowers prices later, Mounjaro would still cost about 30% more than other branded weight-loss drugs, he said.

Lilly declined to comment on its Indian pricing strategy. It said, however, that early response to Mounjaro in India has been "highly encouraging."

Ozempic, Wegovy and Mounjaro belong to a class of drugs called GLP-1 agonists, which mimic a hormone that slows digestion and helps people feel full longer.

Novo has sued Dr Reddy's and Sun Pharma in a local court to enforce semaglutide patents and attempted to block generics until March 2026.

Longer patent protection for Mounjaro's active ingredient, tirzepatide, which extends at least until the middle of the next decade, also gives Lilly an advantage, analysts said.

PARTNERING FOR REACH

The battle has expanded beyond pricing and patents.

Demand for weight-loss treatments in India is spreading beyond urban elites as interest grows among middle-class families, office workers, women nearing menopause and people with obesity-related complications in smaller towns.

Lilly has partnered with India's third-largest drugmaker by revenue, Cipla CIPL.NS, to launch a second tirzepatide brand, Yurpeak, targeting smaller towns, and teamed up with Apollo Hospitals APLH.NS to raise awareness of obesity and diabetes. It is also investing more than $1 billion to expand contract manufacturing in India.

Cipla said it would help market Lilly's weight-loss medication in deeper markets in India.

Meanwhile, Novo has tied up with Emcure Pharmaceuticals EMCU.NS and launched a second semaglutide brand, Poviztra, to widen distribution beyond India's major cities. It has teamed with startup Healthify to offer patients health coaching and with Apollo to raise awareness of obesity.

In India, where prescription drug ads are prohibited, Novo launched a "WeGoWithYou" obesity awareness campaign that connects people to doctors to learn more about the disease and its management. Lilly has a similar initiative known as "WeKnowNow" that talks about obesity management.

Both drugmakers are pushing to frame obesity as a disease, utilizing newspaper ads, billboards, airport displays and pamphlets at wellness clinics.

Neither company disclosed its spending on marketing in India.

($1 = 89.4160 Indian rupees)

(Reporting by Rishika Sadam in Hyderabad, India; Editing by Dhanya Skariachan and Matthew Lewis)

((Rishika.Sadam@thomsonreuters.com;))