From Jab to Pills: Novo Nordisk, Eli Lilly set to take obesity drug battle to India

Mumbai: India's obesity drug market is gearing up for its next big fight-this time over a pill, not a jab.

Danish drugmaker Novo Nordisk's oral Wegovy (semaglutide) and US pharma major Eli Lilly's oral GLP-1 orforglipron are expected to enter India in the first half of 2027, according to industry sources familiar with the regulatory process. Both companies have already submitted their oral products to Indian regulators, said top officials.

Novo CEO Mike Doustdar recently said oral drugs could account for as much as half the global obesity drug market by 2030. The company is placing significant bets on a future dominated by pills.


"When you come across a pill that is almost as efficacious as injectables, then why not?" said one of the people cited.

Another said: "Orforglipron is expected by January-February, followed by oral Wegovy."

One in three US obesity prescriptions are already oral, an industry executive said. Novo and Lilly launched oral weight loss drugs in the US earlier this year.

"Two out of three prescriptions are still of Novo in the US, though Lilly is narrowing the gap," the person said.

Oral weight loss drugs have an average weight-loss efficacy of 12-15%, meaning those who take it are able to shed that proportion of weight over a specified treatment period. That compares with 15-22% for injectables.

Novo, which is aggressively expanding in the oral obesity drug market, struck a deal on Tuesday with China's Hengrui Pharma for HRS-1596, a potential once-weekly oral GLP-1/GIP dual agonist that targets the same hormone pathways as Lily's tirzepatide (Mounjaro). Semaglutide is a single-action (GLP-1) drug.

Doctors said oral GLP-1s will generate two possible pools of demand-needle-phobic patients who have avoided injections so far and existing users who may want to shift from weekly jabs to oral treatment for longer-term weight maintenance. "Novo is really going after these pills now," said a top executive.

"Though this pill from Hengrui is still in Phase 1 and may take 5-7 years, what is important is that it is a once weekly oral GLP1-GIP molecule," said leading diabetologist Rajiv Kovil.

Oral GLP-1s will be a "game changer" for India's obesity drug market, said Vyankatesh Shivane, senior endocrinologist at Mumbai's Jaslok Hospital.

Many patients are already using synthetic (generic) semaglutide from Indian companies and new oral GLP-1s from innovators can make treatment easier. Oral therapy can also be useful for people who have already lost weight on injections and want to maintain their levels, he said. "There are at least 15-20% of patients who do not take the injectable because of the fear," Kovil said. "Pills could also widen the prescribing base as they may be easier for general physicians and other doctors to prescribe than injectables." Some patients who have reached their weight targets after one-and-a-half to two years of treatment are reluctant to remain on weekly injections indefinitely, Kovil said. He expects some of them could shift to oral therapy for staying lighter. "It can always be that you inject to lose and you use a pill to maintain," he said.

Neeraj Tulara, a Mumbai-based diabetologist and general medicine expert, is of the view that oral GLP1s may improve initial acceptance but convenience alone may not solve the bigger problem of long-term adherence. "Pricing will be an important factor," he said.