In the past few days, some private hospitals in Shanghai have received many phone calls to make appointments with Novo Healthcare. Recently, there have been a lot of inquiries over the phone and online. Customers can book in advance online and come for a face-to-face consultation to see if they meet the indications, "said the staff at Yufang Medical Apricot Clinic.
Novo Nordisk is a semaglutide injection developed by Novo Nordisk for long-term weight management in adults. On November 17th, it was officially announced for commercial listing in Shanghai.
Simeglutide is causing a craze in the global market. In the first three quarters of 2024, Novo Nordisk's global sales increased by 23% to $29.46 billion, with sales of semaglutide related products reaching $20.346 billion, accounting for nearly 70% of total sales. But on the other side of the booming sales is the calm capital market. In the past six months, Novo Nordisk's stock price has fallen by over 22%.
Why is there such a two-fold situation in the weight loss market that is constantly expanding and widely favored by the industry?
Novohexidine
Simeglutide has become a well-known "internet celebrity" drug.
In October 2022, SpaceX founder and CEO Elon Musk revealed through social media platform X that he had successfully lost 9 kilograms within a month through a fasting program and Wegovy. The active ingredient of Wegovy is semaglutide.
Elon Musk's response on social media.
Two years later, the "weight loss product" Novogene, which also uses semaglutide as an active ingredient, was officially launched in Shanghai.
From the perspective of its mechanism of action, for obese patients, Novogene can achieve weight loss by inhibiting the feeding center, delaying gastric emptying, reducing appetite, and reducing calorie intake. But industry insiders say that precisely because of this, the most common adverse reactions are manifested through the gastrointestinal tract, mainly symptoms such as nausea, vomiting, diarrhea, constipation, etc.
It is reported that Novoying can achieve an average weight loss of about 17%, and its weight loss effect can last for at least 2 years, and bring multiple health benefits, including but not limited to reducing waist circumference, reducing visceral fat, improving blood lipids, reversing pre diabetes, etc.
However, this is ultimately a prescription drug with a specific target audience. Specifically, Novogene has clear regulations on the initial body mass index (BMI) of patients, which should meet the following conditions - one is BMI ≥ 30kg/m& sup2; The population belongs to obesity; The other type is 27kg/m& sup2;≤ BMI< 30kg/m& sup2; The population is overweight and has at least one weight related complication, such as high blood sugar, high blood pressure, dyslipidemia, obstructive sleep apnea, or cardiovascular disease.
Some gray spaces also need to be cautious. At present, when searching for relevant drugs on platforms such as Tmall, Alibaba Health, Meituan, and Ele.me, you can see information about appointment and retention services.
One of the private hospitals directly replaced the merchant avatar of Meituan with the words "Novo&Ying Delivery". The organization has posted a reservation link on the product homepage for a price of 1630 yuan, corresponding to the "must buy package for beginners", which includes 5 doses of semaglutide injection, a combination of intestinal dietary probiotics, online guidance from weight loss consultants, nutritionist tracking services, and consumables.
Product details on the platform.
As a buyer, the reporter inquired about how to make an appointment. The other party stated that there is no need to provide a physical examination report, and it is okay if the BMI does not meet the indication requirements. "Order first and then do the physical examination. If there is no medullary thyroid cancer, it can be used.
This statement is naturally misleading and must meet the indications before it can be used, "said the industry insider.
GLP-1 "duopoly"
Simeglutide belongs to GLP-1 receptor agonist drugs. Since being proven to have weight loss and blood sugar lowering effects, GLP-1 drugs have become star products in weight loss drugs, and various pharmaceutical companies are competing to enter the market.
In addition to semaglutide, another representative product is Tilpotide developed by Eli Lilly, which is a GIP/GLP-1 receptor agonist. In July of this year, the long-term weight management indication of Eli Lilly and Predaclopeptide Injection (trade name: Mufengda) was approved by the China National Medical Products Administration and has not yet been commercially launched in China.
However, in May 2022, Tilporide has been approved for marketing in the United States, which is applicable to improving the blood sugar of adult type 2 diabetes patients on the basis of diet control and exercise, and its trade name is Mounjaro; At the end of 2023, the weight loss indication was approved again, with the product name Zepbound.
From the current perspective, Novo Nordisk and Eli Lilly occupy 90% of the GLP-1 drug market, and their indications and market size are constantly expanding. JPMorgan Chase predicted last year that by 2030, driven by the "duopoly" of Eli Lilly and Novo Nordisk, the annual sales of GLP-1 drugs would exceed $100 billion.
However, based on the third quarter financial report, the performance of the two "giants" did not fully match market expectations.
Let's take a look at Novo Nordisk first, their performance has indeed far exceeded expectations. According to the financial report, Wegovy generated sales of up to $2.46 billion for Novo Nordisk in the third quarter, far exceeding analysts' widely expected $2.22 billion, with a year-on-year increase of up to 79%.
But Lilly's financial report is not as "surprising". According to the financial report, Lilly's revenue for the third quarter was $11.439 billion, a year-on-year increase of 20%. However, the weight loss drug Zepbound, which is most focused on by the market and uses teppone as an active ingredient, had sales of only $1.26 billion in the third quarter, far below the analysts' general expectation of $1.76 billion; The sales of Mounjaro, a diabetes drug with Tilporide as the active ingredient, in the current quarter were 3.11 billion dollars, also lower than the 3.7 billion dollars expected by analysts.
Zhao Heng, founder of Latitude Health, a medical strategy consulting company, said that the cognitive first mover advantage is an important reason for the sales gap between the two. As early as June 2021, Novo Nordisk Wegovy was approved as a weight loss drug in the United States. Lilly arrived late, and Zepbound was only approved in the United States in November 2023.
The time difference in between is a crucial "advantage" in the drug sales market.
Medical products are not like consumer goods that can be marketed through advertising. Whether it's Wegovy or Zepbound, as prescription drugs, they first need to influence doctors and then patients. When the product enters the market first, it can provide science education to doctors and patients first, and have a cognitive 'first mover advantage'. "Zhao Heng said that this is an important reason for Novo Nordisk's sales exceeding expectations.
The future of "involution"
In fact, apart from the two giants, the GLP-1 race track is already very crowded, and players have different ways of playing. Overall, there are basically two types: developing innovative drugs or waiting for patents to expire to seize the generic drug market.
On the one hand, from the current market layout, drug development targeting GLP-1 receptors has become the mainstream of clinical research on weight loss drugs. Multinational pharmaceutical giants such as Pfizer, Amgen, and Boehringer Ingelheim have products under development; Looking at the domestic market, domestic pharmaceutical companies such as Xinda Biotechnology and Hengrui Pharmaceutical are also laying out innovative drugs on the GLP-1 weight loss track.
On the other hand, generic drug players are gearing up. In the Chinese market, the core patent of semaglutide will expire in 2026. At present, domestic enterprises such as Huadong Pharmaceutical, Lizhu Group, Hanyu Pharmaceutical, and Shiyao Group, which are targeting star GLP-1 generic drugs, are also eager to seize the generic drug market.
However, the recent response from the capital market has not been positive. Over the past six months, Novo Nordisk's stock price has fallen more than 22% and is currently trading at $105.27 per share; Since September this year, Li has also shown a fluctuating downward trend.
Ultimately, it's still a change in expectations, "Zhao Heng said. With more and more players entering, there will definitely be a price war in the future. After the patent expires, the market will truly enter the stage of competing channels and costs. With the gradual increase in the number of drugs on the market, the overall price of GLP-1 drugs may decrease, and market competition is expected to become more intense at that time. At the same time, the overall target audience will not have much expansion, and when the price is "rolled down", the actual market capacity may not be as expected, which is also one of the reasons for the stock price fluctuations of the two giants.
However, there is still a lot of room for imagination in the future of the weight loss track, it depends on what kind of core technologies can emerge. After all, the demand is always there, "Zhao Heng said.
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