But only a few million are receiving treatment, according to Novo Nordisk.
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So what went wrong?
These semaglutide drugs became so popular after their efficacy for weight loss became apparent that, in a sense, they became victims of their own success.
In many markets, including the US and Australia, the two manufacturers, Novo Nordisk and the US pharmaceutical Eli Lilly, couldn’t keep up with demand.
The demand then spurred the creation of copycat drugs – or compounders – which were allowed a sales window by authorities.
And while the window that enabled knockoffs to fill supply has now closed in the US, the black market, once established, isn’t easy to eradicate.
In a notification to investors, Novo Nordisk said: “For Wegovy in the US, the sales outlook reflects the persistent use of compounded GLP-1s, slower-than-expected market expansion and competition.”
“Despite the expiry of the FDA (Food and Drug Administration) grace period for mass compounding on May 22, 2025, Novo Nordisk market research shows that unsafe and unlawful mass compounding has continued, and that multiple entities continue to market and sell compounded GLP-1s under the false guise of ‘personalisation’.”
It then had to confess that full-year sales growth is expected to come in between 8 per cent and 14 per cent, well down on previous guidance of between 13 per cent and 21 per cent.
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But finding a commercial remedy for Novo Nordisk isn’t simple and will require what it calls, aggressive intervention by federal and state regulators and law enforcement.
Meanwhile, US President Donald Trump’s trade turmoil has injected plenty of uncertainty into international pharmaceutical producers, with companies receiving limited visibility on what duties might be imposed on goods being sold into the US.
Until Sunday, European pharmaceutical companies were being threatened with a 200 per cent tariff on sales into the US.
The deal with Europe announced this week may mean the duty could come in at 15 per cent.
Pharmaceutical products had previously been exempt from duties, but the industry was bracing for targeted duties due to US government investigations.
But even a 15 per cent tariff will raise the cost of the drugs and place further strain on sales and negatively affect supply chains.
It will also put Novo Nordisk at a disadvantage relative to its main legitimate rival, the US pharmaceutical group, Eli Lilly, which produces Semaglutide products under the Mounjaro and Zepbound brands.
It is a lesson in how a company that has disrupted the health industry can also be disrupted.
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