WHEN PFIZER INC., the world’s No. 1 pharmaceutical company with 2024 revenues of $63.6 billion, announced the acquisition of Metsera, a biotech startup founded in 2022 with no medicines in the market so far, it did not surprise market watchers. Pfizer’s success in the month-long bidding war with Denmark’s Novo Nordisk marked its entry into the anti-obesity drugs segment, which is also one of India’s fastest-growing.

New York-headquartered Pfizer paid approximately $7 billion, with a commitment to pay up to $3 billion more, based on three specified clinical and regulatory milestones that Metsera’s experimental drugs are likely to achieve. Pfizer’s single-largest money spinner is currently Eliquis, its brand for the anticoagulant apixaban, for which it shares a patent with Bristol Myers Squib. Eliquis generated sales of $7.4 billion in 2024, or 12% of its total revenues.

For Novo Nordisk, the world’s No. 12 pharma company with revenues of $42.1 billion, Metsera’s pipeline would have added to its clutch of anti-obesity blockbusters. Novo Nordisk’s Ozempic (semaglutide) fetched revenues of $17.45 billion in 2024.

What was Metsera developing? Its lineup includes glucagon-like peptide-1 (GLP-1) agonists, which have become a hit in managing obesity and treating diabetes. Novo Nordisk also sells GLP-1 semaglutide injectables under the brand names Ozempic and Wegovy, as well as Rybelsus, the only oral form.

The GLP-1 class is driving growth in the pharmaceutical sector. Every pharma major — big or small, innovator or generics maker — is eyeing the GLP ‘Gold Rush’ as more people get overweight and obese and fall victim to diabetes.

Take Eli Lilly, the world’s 11th largest pharma company by revenues. Its biggest-selling drugs in the U.S. are Mounjaro (cleared only for the management of diabetes) and Zepbound (approved for weight loss), both based on tirzepatide. Lilly said it sold $24.8 billion worth of Mounjaro and Zepbound in the first nine months of 2025, and that its tirzepatide brand had become the world’s largest-selling drug so far this year.

Following the announcement, Lilly’s share price on the New York Stock Exchange soared on November 21, making it the first healthcare company to hit a market cap of $1 trillion and join the ranks of technology companies in the trillion-dollar club.

Novo Nordisk has also been setting market capitalisation records: on July 13, 2024, it hit $635 billion. Novo Nordisk and other pharma companies are driving growth in Denmark’s GDP, and Novo Nordisk’s market cap exceeds its home country’s GDP.

Analysts differ on the numbers for growth in demand for GLP-1 drugs, but the consensus is the adjective ‘exponential’. Goldman Sachs estimates the global GLP-1 market will touch $100 billion by 2030. PwC has a more optimistic figure in mind: $150 billion by 2030.

Obesity and diabetes are ballooning health concerns across the globe, especially in the world’s most populous countries such as India and China.

Emerging battlefield

Pharma companies milk innovative drugs for revenues as long as the molecules are protected by patents, especially in developed markets such as the U.S., the world’s largest pharma market. Lilly’s fortunes were also rooted in the U.S., though its global sales figures for the October quarter show that increasing volumes in non-U.S. markets somewhat offset the lower price realisation of its GLP-1 drug.

Lilly’s worldwide revenue from Mounjaro, the brand for its patented molecule tirzepatide, increased 109% YoY to $6.52 billion during July-September 2025 (Q3). The company said that while its U.S. revenue was $3.55 billion, an increase of 49% YoY, reflecting strong demand, partially offset by lower realised prices, its revenue outside the U.S. increased to $2.97 billion from $728 million in the same quarter of 2024, primarily driven by volume growth.

India is an important future market. Government numbers say 7.5% of India’s 1.4 billion people are obese, coupled with a huge burden of diagnosed and undiagnosed diabetes cases. If volumes are to drive GLP-1 sales in the coming days, India is a key market, which, incidentally, Lilly seems to be beginning to experience.

On March 20, Lilly launched Mounjaro in India as the first-of-its-kind treatment for obesity and Type 2 diabetes. Tirzepatide is a dual GIP and GLP-1 receptor agonist: it mimics the actions of the hormones GIP and GLP-1, which our gut normally produces after we eat. GIP helps release insulin, which regulates blood sugar levels, while GLP-1 helps reduce appetite.

Winselow Tucker, president and general manager, Lilly India, says obesity and Type 2 diabetes are rapidly emerging as a major public health challenge in India. Lilly, he says, is committed to collaborating with the government and industry to promote awareness and improve the prevention and management of these diseases.

“Our mission to make life better for people living with obesity and diabetes in India is reflected in our efforts to accelerate the introduction of innovative medicines. The launch of Mounjaro demonstrates our ongoing support for this mission and our shared vision of a healthier nation,” says Tucker, who has earlier worked at Bristol Myers Squibb and Novartis.

Mounjaro has taken the market by storm. According to the October report of market intelligence firm IQVIA, Mounjaro has become a ₹543.9 crore brand in India in less than a year. Against this, the 2,964 brands introduced by the pharmaceutical industry in India during the 12 months ending October netted a total of ₹1,977 crore.

But, while GLP-1 drugs are expected to boost pharma sales, Lilly may not be the only beneficiary. The competition is trying to catch up.

Competition heats up

On June 24, three months after Lilly launched Mounjaro in India, Novo Nordisk, its global competitor in the GLP-1 segment, rolled out its blockbuster GLP-1 semaglutide injection (under the Wegovy brand) in India.

Vikrant Shrotiya, MD, Novo Nordisk India, says the company pitched Wegovy as the first and only obesity medication that not only manages chronic obesity, but also major adverse cardiovascular events (MACE).

“We are bringing Wegovy to Indians as a transformative and evidence-based therapeutic solution with the convenience of a world-class, state-of-the-art pen device. Additionally, we have an India-specific price,” says Shrotiya, who has 20 years in pharma, including an earlier stint at Abbott Laboratories, the U.S. major.

Wegovy has yet to break Mounjaro’s sales charts in India, but that doesn’t mean there is a monopoly. Tirzepatide (Mounjaro) has more years of patent protection ahead, while the patent of semaglutide (Wegovy) will expire in India and other markets (where volume matters) next year.

Sensing a price war ahead, Lilly announced in October a partnership with domestic pharma major Cipla to distribute and promote tirzepatide in India under a second brand name, Yurpeak. The idea was to expand the availability of tirzepatide by enabling broader access beyond cities where Lilly already has an established presence.

Lilly’s Tucker says, “The introduction of a second brand of tirzepatide in India through our commercial agreement with Cipla furthers Lilly’s commitment to expanding access to innovative treatments for chronic conditions.” Lilly will manufacture and supply Yurpeak to Cipla, and the price will be the same as Mounjaro.

In November, Novo Nordisk said it had partnered with Pune-based Emcure Pharma to launch Poviztra, another semaglutide injection brand, in India. The partnership, however, covers only a single strength, 2.4 mg, of the injection, while Wegovy is available in multiple strengths. The collaboration is again meant to increase market reach beyond Indian metros and big cities.

“We are thrilled to partner with Novo Nordisk India to bring Poviztra to India and are proud to be the first Indian pharmaceutical company to bring the world’s most widely used and trusted GLP-1-based weight loss molecule to the Indian market. We believe in the potential of semaglutide,” says Satish Mehta, CEO and MD, Emcure Pharma.

Emcure’s ‘strong understanding’ of India’s diverse geographical landscape and established marketing capabilities make it confident it can make this molecule available to patients who need it the most, he adds.

Generic readiness

Lilly will face a pricing challenge, but nothing compared with what Novo Nordisk’s semaglutide will face once the molecule’s main patent in India expires and Novo Nordisk finds itself ranged against generics.

Equity advisory Intelsense, in a May 2025 update, states that India’s overall weight management industry today is worth about $25 billion and could more than double to $56 billion by 2033. The launch of generic semaglutide injectables could turbocharge the Indian GLP-1 market, making it far more affordable and accessible to millions, it pointed out.

Novo Nordisk fired the first broadside in the price war on November 11 with a 37% cut on all strengths of Wegovy, its semaglutide brand. The weekly price for the initiation dose (0.25 mg) will now be ₹2,712, down from ₹4,336.

The generics players are securing regulatory approvals to be ready with their semaglutide versions as soon as the patent expires in 2026. A dozen companies have approached the Central Drugs Standard Control Organisation (CDSCO) for permission to conduct bioequivalence or phase III clinical trials as the final steps toward marketing approval for the generic semaglutide.

A look at the recommendations given by the Subject Expert Committee (Endocrinology & Metabolism) of the CDSCO in the last year indicates that the companies that are trying to sell semaglutide generics include Sun Pharmaceutical Industries, Torrent Pharmaceuticals, Zydus Lifesciences, Macleods Pharmaceuticals, Hetero Labs, Alkem Laboratories, Intas Pharmaceuticals, Dr Reddy’s Laboratories, MSN Laboratories, Lupin and Virchow Laboratories.

Indian companies are also scouting markets for generic semaglutide in countries where the patent is due to expire. An ICICI Direct investor note prepared in May suggests that Dr Reddy’s is considering launching a generic semaglutide in Canada and Brazil, in addition to India.

Misuse a worry

The International Diabetes Federation has some worrisome numbers for India. Its Diabetes Atlas 2025 says that, if left unchecked, the country’s adult diabetes population could grow from the current 89.8 million to 156.7 million by 2050. It also estimates that India had 38.6 million adults living with undiagnosed diabetes in 2024.

The World Obesity Federation, which has a formal consultative status with the World Health Organization, gives another set of scary numbers. It says that the direct and indirect costs of overweight and obesity could cost $81.53 billion or 1.57% of GDP if left unattended. A class of drugs which could effectively control both could thus be a miracle drug.

Therein lies the rub. Experts say Indian regulators have to ensure that anti-obesity drugs are not misused as over-the-counter pills. They cite the lawsuits being filed in the U.S. against alleged side effects of GLP-1 drugs, which their makers are contesting vigorously. If an advanced economy like the U.S. cannot control the misuse of these drugs, can Indian regulators ensure these drugs are used under strict medical supervision?

A Mumbai-based endocrinologist and medical researcher, Shashank R. Joshi, says that GLP-1 as a class is almost 25 years old and safe, but if a drug works, it will have effects and side effects. “Pharmacovigilance is always the key. These drugs should not be taken over the counter. They should be taken under the prescription of a medical endocrinologist. And, in general, one needs to be pharmacovigilant,” he says.

The benefits seem to outweigh the adverse events. The newer generation of drugs and competition should increase effectiveness, access and affordability in future. What needs to go hand in hand is ethical marketing, rational prescription and responsible use of medicines. GLP-1 is no exception.