Even as pharmaceutical companies, drug trade, doctors and regulators are expecting a surge in the demand for obesity and diabetes drug semaglutide after its patent validity expires in India and generic brands get launched later this month, a stakeholder survey conducted by market intelligence firm Pronto Consult shows more than 50 brands are expected to enter the market within weeks of market exclusivity currently enjoyed by the patent holder, Danish drug major, Novo Nordisk. However only a handful will gain market acceptance in the long run, the survey suggests.

According to Pronto, long term leaders among this GLP-1 class of medicine will be 5 to 6 brands, and 9–12 brands will likely be recalled by doctors after the first 12 months. The survey suggests that 72% of the respondents expect multiple brands with prefix ‘sema’ to hit the markets one the generic floodgates open. Currently, Novo Nordisk markets the molecule under brand names like Wegovy, Ozempic and Rybelsus.

“In medicine, doctors rarely remember every brand that enters a therapy class. They remember the few that worked best for their patients. The real competition does not occur at launch. It occurs between months 3 and 12, when doctors decide which brands deserve to remain in their prescribing memory. Even though 50+ brands may enter the market, the clinical ecosystem will eventually behave as if only a handful exist”, says Hari Natarajan, founder and managing director, Pronto Consult. The pattern is consistent with several historic therapy markets where initial brand proliferation eventually collapses into a small leadership cluster, he says. Among the doctors who responded to the survey, 81% said the second prescription determines brand continuity while 54% doctors anticipate difficulty distinguishing multiple similar brand names.

According to Natarajan, retention of prescription and not initial prescription that matters and while price and affordability is the most influential factor for 82% of doctors who were surveyed, only 39% considered that to be a reason for retention. Side effect management support (82%), availability in local pharmacy (71%), brand usability or comfort (64%) were more important factors that determined retention of prescriptions by doctors, it revealed.

“The GLP-1 opportunity in India is not a genericisation cycle. It is the birth of a chronic metabolic platform market. The companies that treat semaglutide as a molecule will compete on price. The companies that treat obesity as a lifelong behavioural journey will build structural dominance. By 2030, the winners will not be those who sold the most in year one. They will be those who engineered the most refills over five years. This is not a prescription war. It is a persistence war”, Natarajan says.

Incidentally, India’s top drug regulator, the Drugs Controller General of India (DCGI), has taken note of the awareness campaigns carried out by some pharmaceutical companies on obesity, and issued strict warning against unethical marketing of GLP-1 drug and possible surrogate advertisements. The umbrella body of chemists and pharmacies - All India Organisation of Chemists and Druggists (AIOCD) – has also written to its retail chemist and wholesale distributor members to ensure that GLP-1 category of medicines including semaglutide brands are dispensed on the basis of prescriptions from qualified medical practitioners.

Pronto survey suggests that whatever be the tactic to capture semaglutide market share, the winners will not simply be those who launch first or have the price lowest or promote the loudest. “The winners will be those who convert a crowded molecule into a trusted therapy experience. Because in the end, while molecules create markets, it is trust that creates leaders. The ‘SEMA’ Storm may begin as an avalanche of brands, but history suggests it will end as a short list of trusted names shaping India’s next chapter in metabolic care and the companies that recognise this early will not just survive the storm. They will define it”, Natarajan says.