Sales of weight-loss drugs are sky-rocketing in South Africa, as it has in other parts of the world. But as the popularity of the so-called wonder drug rises, so too is the number of complaints about serious side effects which have now led to a 4 000-strong class action suit against the manufacturers, writes MedicalBrief.
In the latest concern flagged about weight loss drugs, the Medicines and Healthcare Products Regulatory Agency (MHRA) in Britain has warned people using injections like Wegovy to be aware of the rare but real chance of developing severe inflammation of the pancreas, known as acute pancreatitis (see more below).
The warning comes as 4 400 patients have filed lawsuits against the drug producers since 2023, with around 75% of them saying they have been left with gastroparesis, a type of stomach paralysis that slows the emptying of the stomach. Another 8% have reported very severe gastrointestinal complications, including extreme vomiting (see more below).
In South Africa, however, it is still early days for the drugs. According to Mediscor, which assists medical schemes in managing medicines benefits for their members, spending on Ozempic has risen sharply here.
In Spotlight, Catherine Tomlinson writes that Mediscor’s 2024 Medicines Review, published in September 2025, shows that Ozempic surged from position 170 in 2023 to position 12 in 2024 on its list of top drivers of medicine spending by medical schemes and their beneficiaries.
Wegovy was not yet available in the country and so was not included in this analysis, but Aspen’s Dr Stavros Nicolaou said that according to IQVIA, (which tracks and sells data on global medicine sales), sales of Mounjaro have now eclipsed all other medicines in South Africa.
“It's the largest pharmaceutical product in South Africa… it achieved that status in November,” said Nicolaou. IQVIA’s medicines sales data for South Africa is not available in the public domain.
The explosion in sales of and spending on GLP-1 medicines is unlikely to slow any time soon as the popular game-changer medicines are increasingly being used to manage obesity.
The South African Metabolic Medicine and Surgery Society (SAMMSS) published new clinical practice guidelines in November 2025, recommending the use of GLP-1s for treatment of obesity alongside other interventions.
GLP-1s are also under investigation for treating and preventing numerous diseases, including obstructive sleep apnoea, substance use disorders, kidney disease, liver disease, and neurological disorders.
The GLP-1 medicines currently available in South Africa are all formulated as injections, and the market is likely to expand further as they become available in oral forms. A pill form of semaglutide was recently approved by the US Food and Drug Administration, while a second GLP-1 pill is expected to get the green light in the US later this year. Neither is yet available in South Africa.
Medical schemes coverage
Despite rapid growth in sales of GLP-1s in South Africa’s private sector, many people who could benefit from these treatments and have costly medical scheme coverage still can’t access them, due to their high costs and limited coverage for the jabs.
When used for weight management, a maintenance dose of semaglutide and tirzepatide generally costs between R3 000 and R6 000 per month (but can exceed this amount).
The price depends on the required dose, with higher doses being significantly more expensive than lower‑dose products.
Coverage for diabetes
While South African medical schemes are required by law to cover the treatment of diabetes as a prescribed minimum benefit, they are not required to cover the costs of GLP-1s and often provide only limited coverage for these medicines.
Dr Noluthando Nematswerani, chief clinical officer at Discovery Health, told Spotlight it provides coverage for GLP-1s for treatment of diabetes only when certain clinical criteria are met. “If the criteria are not met, these medicines are funded from the member’s available day-to-day benefits (Medical Savings Account and Above Threshold Benefit, where applicable),” she said.
Coverage for obesity
Coverage for GLP-1s for weight management is even more limited as obesity is not a prescribed minimum benefit condition, so medical schemes are not mandated to cover treatment costs.
“There are numerous challenges regarding reimbursement of any treatment options for obesity – this includes surgery and medication. SAMMSS has negotiated continuously with funders and will continue to do so,” said Dr Marli Conradie-Smit, director of SAMMSS and an endocrinologist at Stellenbosch University and Tygerberg Hospital.
“For the first time we have a clinical practice guideline that indicates ideal care of obese people,” said Conradie-Smit. The next steps would be dissemination and information to be shared to healthcare practitioners and to public and private stakeholders.
“This will have to address accessibility and affordability of treatment options, which includes metabolic and bariatric surgery, and medication.”
Generic manufacturers ready
More affordable generic GLP-1 products are expected to become available on the global market from next year.
Tahir Amin, CEO of I-MAK, a US-based non-profit working to improve medicine access globally, said: “Brazil, China and India should see the key compound patents for semaglutide expire this year and with it, generic entry.” He said various companies in China and India are already lined up to launch this year.
Another country in which generic products are expected to become available this year is Canada. Nine generic manufacturers, including Aspen, have already filed regulatory applications to market generic semaglutide in Canada.
Nicolaou said that Aspen indicated that the first market in which the South African company would potentially launch generic semaglutide would be Canada. “We will be launching and commercialising biosimilar semaglutide according to the patent cycles across the world… according to where you see patents coming off first,” he said. “We'll continue to follow that track, including for South Africa.”
Generics for South Africa?
Spotlight reviewed the patents on semaglutide and tirzepatide in South Africa, based on publicly available patent data published by the United Nations-backed Medicines Patent Pool, as well as South Africa’s Companies and Intellectual Property Commission.
According to our analysis, Novo Nordisk has sought 15 patents related to semaglutide in South Africa. One patent has expired, three are pending, and 11 have been granted.
The patents sought by Novo Nordisk on semaglutide in South Africa include a patent on semaglutide’s chemical compound or active ingredient, as well as patents on different preparations and doses of semaglutide, different clinical indications for which it is used, and the pen injector used for delivery.
Novo Nordisk’s patent on semaglutide’s chemical compound (ZA200707261) expires in 2027. After expiry of this patent, generic versions may enter the market, as has occurred in other countries.
However, Novo Nordisk may seek to block generic sales in the country by asserting that its other patents related to semaglutide are infringed by generic entry. If this occurs, a decision regarding whether generic products can be sold in South Africa will probably have to be made by South African courts.
Regarding tirzepatide, our analysis of patents granted SA suggests that generic versions of Mounjaro are still years off, as key patents granted on this product do not expire until the 2030s.
For now, the high cost of patented GLP-1s and absence of generics remains a major impediment to access in South Africa.
On the bright side, generic versions of semaglutide will become available in many countries this year, resulting in better supply and lower prices globally. In South Africa, these cheaper products may hit the shelves by 2027.
Dire side effects, legal cases
Meanwhile, more than 4 000 American patients have filed lawsuits against drug producers claiming side effects from the drugs, while in Britain, health authorities have issued a warning about the potential risk of pancreatitis, also tied to GLP-1s, reports The Independent.
The companies maintain their products are properly tested.
According to USA Today, 4 400 patients have filed lawsuits against the drug producers since 2023. The ages of the plaintiffs range from 18 to 87.
Around 75% of them say they have been left with gastroparesis, a type of stomach paralysis that slows the emptying of the stomach. Another 8% have reported very severe gastrointestinal complications, including extreme vomiting.
The drugs companies have said they will defend against the claims in court, with test trials not expected until 2027.
One 72-year-old whose symptoms are particularly severe said that last year, while driving, she’d heard a bang – similar to the popping of a balloon – inside her stomach.
She drove straight to a hospital where she was diagnosed with a ruptured colon and sepsis, and spent five days in the hospital.
In January this year, she became one of the thousands of people suing Novo Nordisk, which produces both Wegovy and Ozempic.
In another case a 63-year-old, one of the many people who started taking Ozempic for diabetes, went blind in one eye in October 2023. He had suffered an “eye-stroke” – also known as NAION – which restricts blood to the optic nerve.
Ozempic labels warn that semaglutide can cause NAION in up to one in 10 000 people.
And the pancreas…
In Britain, the Medicines and Healthcare products Regulatory Agency (MHRA) warned people using injections like Wegovy to be aware of the rare but real chance of developing severe inflammation of the pancreas, known as acute pancreatitis.
Symptoms to look out for include extreme pain in the stomach and back, which does not go away, reports the BBC.
Dr Alison Cave, the MHRA’s chief safety officer, said that for the vast majority of patients prescribed GLP-1s, they are safe and effective medicines which deliver significant health benefits.
“The risk of developing these severe side effects is very small, but it is important that patients and healthcare professionals are aware and alert to the associated symptoms,” she said, adding that there had been hundreds of reports of acute and chronic pancreatitis from people who have taken GLP-1s, although none is confirmed as being caused by the medicines.
Most people with acute pancreatitis start to feel better within about a week and have no further problems, but some people can go on to develop serious complications.
In a joint court filing in 2024 detailing their intentions to fight the claims, Novo Nordisk and Eli Lilly said that their products went through rigorous testing.
“The safety profile of GLP-1 RAs has been well-established in hundreds of clinical trials, large-scale observational studies, and nearly two decades of real-world use,” they stated.
BBC article – Weight loss jab users warned over rare but serious pancreas issue (Open access)
See more from MedicalBrief archives:
SAHPRA grants Mounjaro jab approval for weight loss
US man sues for blindness after taking Ozempic
Nordisk slams study linking rare blindness to semaglutide
US study finds serious side effects from weight-loss drugs