On November 14, the world marks World Diabetes Day, and this year's two-year theme is early action on diabetes. India has a fresh reason to pay attention. In March, the patent on semaglutide, the injection sold as Ozempic and Wegovy, ran out in India, and nearly 40 Indian companies entered the market with their own versions.
The price fell fast. Researchers at the Madras Diabetes Research Foundation, writing in the journal Diabetes Care, report that a month's supply dropped from a range of ₹11,000 to ₹16,400 to a range of ₹2,000 to ₹3,500. Sales of all semaglutide injections, branded and generic, rose from about 25,000 units in February to 170,000 in April, according to the same review and to Pharmarack market data.
Indian manufacturers deserve credit for that. Whether more patients can now get the drug is a separate matter.
The researchers say the newer GLP-1 drugs, the class that includes semaglutide, still reach mainly urban and higher-income patients. They add that public health insurance does not fully cover outpatient medicines for chronic illnesses, diabetes drugs included. The sales figures also count units sold, not people treated, and they do not say how many buyers have diabetes and how many want to lose weight.
The drug regulator has already stepped in. Days before the patent ran out, the Drugs Controller General of India told manufacturers to stop surrogate advertising, which promotes a prescription drug indirectly, and any other indirect promotion that could mislead buyers or push the drugs for uses the regulator has not approved. Inspectors also stepped up checks on unauthorised sales, Medical Dialogues reported.
{{/usCountry}}The drug regulator has already stepped in. Days before the patent ran out, the Drugs Controller General of India told manufacturers to stop surrogate advertising, which promotes a prescription drug indirectly, and any other indirect promotion that could mislead buyers or push the drugs for uses the regulator has not approved. Inspectors also stepped up checks on unauthorised sales, Medical Dialogues reported.
{{/usCountry}}Now take the medicines that already cost very little. Researchers analysing the Longitudinal Ageing Study in India reported in The Lancet Global Health last year that about one in five Indians aged 45 and above had diabetes, roughly 50 million people. About four in ten of them did not know it. Among those already diagnosed, 45.7% had their blood sugar under control, as measured by a blood test called HbA1c, which reflects average sugar over about three months. The data come from 2017 to 2019 in most states, so the numbers are several years old. Our NFHS-5 analysis of 688,349 women aged 15–49 years found that 6.3% had screen-detected hyperglycaemia, with state-level prevalence ranging from 2.1% to 11.4%. These findings highlight the need for earlier screening, particularly among women of reproductive age.
Diabetes damages the heart and blood vessels, which is why doctors usually add a cholesterol-lowering pill such as a statin. Only 6.4% of diagnosed patients said they took any cholesterol-lowering medicine. The study's authors caution that the question went only to people who reported high cholesterol, so the true share may be higher.
Medicines also run out where patients collect them. A survey by the Indian Council of Medical Research and the World Health Organization, published in the Indian Journal of Medical Research in 2025, covered 415 health facilities in 19 districts across seven states. Of 105 sub-centres, the village-level outposts that are often a patient's first contact with the public system, 37 (35.2 %) said they had run out of metformin in the previous year. Metformin is the first tablet doctors usually prescribe for type 2 diabetes, the most common form of the disease. The typical stock-out lasted between one and seven months, depending on the medicine. The fieldwork took place in 2021 and 2023, and the sample is small, so the numbers show a pattern more than a national count. A patient facing an empty shelf can buy the tablets from a private chemist or go without.
Public money should go first to four things.
Start with a reliable basic kit. Government figures reported in July put the number of Ayushman Arogya Mandirs, the upgraded health centres where many villagers first seek care, above 1.86 lakh. Each should always stock metformin, a second sugar-lowering tablet, a statin and a blood pressure drug. Insulin needs a fridge, and both insulin and glucose test strips need trained staff and follow-up visits, so they can start at the larger primary health centres and reach the mandirs as these become ready. States already buy free medicines under the National Health Mission. A dashboard open to the public, showing which facilities have run out, would let villagers, district officials and legislators see the gaps.
Statins come next. They are old generic tablets, so a rule that offers one to every eligible patient costs little. The World Health Assembly adopted global diabetes targets in 2022, and one of them is that 60% of people with diabetes aged 40 and above take a statin by 2030.
Evidence should then decide who gets the newer drugs. SGLT2 inhibitors and GLP-1 drugs such as semaglutide can protect the heart and kidneys of some patients, and the Madras researchers report that prices of these drugs fell by 60 to 90% once generics arrived. The government's Health Technology Assessment in India programme should say publicly, and soon, which patients in the public system benefit most, for example those who already have heart or kidney disease. Public purchasing should follow that list instead of what manufacturers promote.
Quality also needs close attention. With nearly 40 companies selling the same injection, India should have regular batch testing and a monitoring system that does not rely on doctors to report side effects on their own.
A government's diabetes record will be judged on whether a daily-wage worker in Bahraich or Barmer can collect her metformin and her statin free, every month, without a missed refill. Early action on diabetes starts there. A cheaper injection for people who can pay is welcome, but the tablets missing from public shelves are the bigger story.
(The views expressed are personal)
This article is authored by Dr Mohammad Hifz Ur Rahman, assistant professor, public health, College of Medicine and Health Sciences, National University, Oman, and Dr Margubur Rahaman, public health researcher, New Delhi, India.