Novo Nordisk is launching a cheaper authorised version of its blockbuster diabetes drug Ozempic in South Africa, intensifying its fight against unregulated compounded medicines, lower-cost generics and Eli Lilly’s fast-growing Mounjaro.
Novo Nordisk’s Extensior will use the same semaglutide ingredient, manufacturing process and injection device as Ozempic.Thomson Reuters
- Novo Nordisk will launch a lower-cost authorised version of Ozempic in South Africa on July 27.
- The rollout follows its court victory against a pharmacy accused of producing unregistered semaglutide medicines at scale.
- Novo is also facing stronger competition from Eli Lilly’s Mounjaro and a newly approved generic from India’s Sun Pharma.
- South Africa’s GLP-1 market has tripled in 18 months to about $134 million as demand for diabetes and obesity treatments rises.
The Danish drugmaker said the product, called Extensior, would become available on July 27 through a partnership with Swiss pharmaceutical company Acino.
Extensior contains semaglutide, the same active ingredient used in Ozempic, and will be sold in the same 0.25 mg, 0.5 mg and 1 mg doses.
Unlike a conventional generic, the authorised copy is made by Novo Nordisk using the same active ingredient, production process and injection device as Ozempic but marketed under a different name.
Novo has not disclosed the price. Sara Norcross, general manager of Novo Nordisk South Africa, told Reuters that the company would announce pricing before the launch but confirmed that Extensior would cost less than branded semaglutide for type 2 diabetes.
The rollout could expand access to semaglutide in South Africa, where the high cost of GLP-1 medicines has pushed some patients towards cheaper compounded products sold outside conventional pharmaceutical supply chains.
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However, the timing also suggests that Novo is moving quickly to defend its position in a market being reshaped by regulatory action, patent expiry and new competitors.
Ozempic and Wegovy are both forms of semaglutide, a drug originally developed for diabetes.Ozempic and Wegovy are the brand names used by the drug manufacturer, Novo Nordisk.Semaglutide works by suppressing appetite, but side effects such as muscle loss, nausea, and diarrhea have been reported, and it’s common to regain the weight after stopping treatment.Semaglutide originated as a diabetes medication but was FDA-approved to treat obesity in 2021. Tirzepatide is a similar “game-change” drug, but it is yet to be approved for weight loss.There have been shortages of the drugs as people clamor to get their hands on them, and while some celebrities have been open about using the medications, others have denied it amid speculation.Business Insider USA
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Launch follows court fight over compounded drugs
Extensior’s launch comes weeks after Novo Nordisk secured an interim order from the Gauteng High Court preventing South African pharmacy group iDexis from manufacturing, marketing and selling compounded semaglutide medicines.
Novo accused iDexis of producing unregistered semaglutide products on a commercial scale and operating outside the exemptions that allow pharmacists to prepare medicines for individual patients.
The court ruled in June that the pharmacy should stop producing the medicines while investigations by the South African Health Products Regulatory Authority and the South African Pharmacy Council continued. Novo alleged that iDexis had been producing about 84,500 units monthly.
South African law permits compounding for the specific needs of individual patients but does not allow pharmacies to use the exemption for large-scale commercial manufacturing.
Regulators said a May inspection of iDexis uncovered serious compliance failures involving semaglutide, tirzepatide and combination GLP-1 medicines. The products found at the site were seized, while authorities later ordered their recall.
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iDexis has appealed the court order and is separately challenging the findings made by the two regulators. It said it had stopped production in compliance with the ruling but disputed allegations that its medicines presented safety risks, citing independent tests that it said found no breaches.
The appeal means Novo’s legal fight is not over. Still, the introduction of a cheaper company-authorised product addresses one of the conditions that helped compounded versions gain customers: the affordability gap between strong patient demand and the price of branded GLP-1 treatments.
Novo Nordisk’s Extensior will use the same semaglutide ingredient, manufacturing process and injection device as Ozempic.Milko/Business Insider USA
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Generic competition is also arriving
Novo is not only competing against compounded versions.
India’s Sun Pharmaceutical Industries received South African regulatory approval this week to manufacture and market a generic semaglutide injection for adults with inadequately controlled type 2 diabetes.
The clearance followed the expiry of Novo’s principal South African semaglutide patent in March and made South Africa the second country after India where Sun Pharma has secured approval for the product.
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Sun Pharma’s product will be offered as a pre-filled, multidose injection pen in 2 mg and 4 mg strengths. A commercial launch date and price have not yet been announced.
The two products are also legally different.
Extensior is an authorised copy manufactured by Novo Nordisk itself, while Sun Pharma’s version is an independently manufactured generic that received regulatory approval after patent protection expired.
The developments mean Novo is preparing to compete on price rather than relying only on the Ozempic brand and its previous patent position.
Eli Lilly’s Mounjaro captured more than half of South Africa’s GLP-1 market by January 2026, increasing competitive pressure on Novo Nordisk..CR/Business Insider USA
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The pressure is also coming from Eli Lilly.
Mounjaro, which contains tirzepatide, was introduced in South Africa in late 2024 through local pharmaceutical manufacturer Aspen Pharmacare. It has since emerged as a major competitor to Novo’s Ozempic and Wegovy medicines.
South Africa’s GLP-1 market tripled in value over 18 months to about $134 million (R2.2 billion), according to figures disclosed by Aspen in March.
Mounjaro’s share of the market increased from 21% in April 2025 to 52% by January 2026, helped by its regulatory approval for chronic weight management. Its sales were projected to exceed about $79 million (R1.3 billion) by June.
Novo responded earlier this year by reducing some South African prices for Wegovy, its semaglutide treatment registered for chronic weight management.
Extensior now gives the company another lower-cost offering, although it is being introduced for type 2 diabetes rather than as an obesity treatment.
The distinction matters because Ozempic is registered in South Africa for type 2 diabetes, even though semaglutide products have generated extensive demand worldwide because of their ability to reduce appetite and support weight loss.
Novo Nordisk recently secured a court order stopping a South African pharmacy from producing compounded semaglutide medicines at scale..Michael Siluk/UCG/Universal Images Group
South Africa is the largest pharmaceutical market in sub-Saharan Africa, making it an important entry point for global drugmakers seeking to expand across the continent.
It also has one of Africa’s heaviest obesity burdens. World Health Organisation data show that South Africa had the highest adult obesity prevalence in the WHO African region in 2022, with roughly three in every 10 adults affected.
The International Diabetes Federation estimates that about 2.3 million South African adults were living with diabetes in 2024, representing 7.2% of the country’s adult population.
Those figures have created a valuable market for drugmakers but also expose an access problem.
The rapid growth of Mounjaro, Ozempic and Wegovy has largely occurred within South Africa’s private healthcare market, while high prices and limited insurance coverage put the medicines beyond the reach of many patients.
That gap has encouraged demand for cheaper compounded or unauthorised alternatives, prompting repeated safety warnings from SAHPRA.
The regulator has warned that compounded, falsified and substandard GLP-1 medicines may contain incorrect active ingredients, unreliable doses or ingredients obtained from unverified
Novo’s new product therefore serves two purposes- it gives patients a cheaper regulated option while helping the company protect its market from compounders, generics and Eli Lilly.
Whether it meaningfully expands access will depend on the price announced before the July 27 launch, and how it compares with Ozempic, Mounjaro and the generic alternatives now preparing to enter South Africa.
