South Africa Grapples with Access to Weight Loss Drugs as Demand Soars

JOHANNESBURG, South Africa – A new wave of weight-loss medications, including Ozempic and Mounjaro, is rapidly gaining popularity in South Africa, but remains largely inaccessible to those who need them most due to high costs and limited public healthcare coverage. The surge in demand reflects a global trend, prompting debate about obesity as a disease and the ethical considerations surrounding access to these potentially life-changing drugs.

These medications belong to a class of drugs called glucagon-like peptide-1 receptor agonists (GLP-1s), initially developed to treat type 2 diabetes. Their remarkable ability to promote weight loss has led to widespread “off-label” use, driving up sales even as affordability remains a significant barrier.

Data from Mediscor, a South African company that assists medical schemes with medicine benefits management, reveals a dramatic increase in Ozempic spending. The drug jumped from the 170th most-funded medication by medical schemes in 2023 to the 12th in 2024, according to Mediscor’s 2024 Medicines Review, published in September 2025. Mounjaro, launched in South Africa in December 2024, is also experiencing skyrocketing sales, reportedly becoming the largest pharmaceutical product in the country within months, according to Aspen Pharmacare, the drug’s distributor in South Africa. IQVIA, a global medicine sales data tracker, confirms this trend, though its South African data isn’t publicly available.

“It’s the largest pharmaceutical product in South Africa… it achieved that status in November,” said Dr. Stavros Nicolaou of Aspen Pharmacare.

The high cost is the primary obstacle. A monthly maintenance dose of semaglutide (Ozempic/Wegovy) or tirzepatide (Mounjaro) typically ranges from 3,000 to 6,000 South African Rand (approximately $160-$320 USD), and can exceed that amount depending on the dosage.

Currently, South Africa’s public healthcare system does not offer GLP-1s, and private medical schemes often provide limited coverage, primarily for patients with diabetes who meet specific clinical criteria. Dr. Noluthando Nematswerani, chief clinical officer at Discovery Health, explained that coverage for diabetes treatment is mandated by law as a prescribed minimum benefit, but GLP-1s are not automatically included.

“If the criteria are not met, these medicines are funded from the member’s available day-to-day benefits,” she said. Coverage for weight management is even more restricted, as obesity is not considered a prescribed minimum benefit.

This disparity in access is fueling calls for a re-evaluation of obesity as a public health issue. Authors of a recent Lancet report argue that obesity should be recognized not just as a risk factor for other diseases, but as a disease in itself, potentially warranting broader healthcare coverage. The South African Metabolic Medicine and Surgery Society (SAMMSS) recently published clinical practice guidelines recommending the use of GLP-1s in obesity treatment alongside other interventions.

“For the first time we have a clinical practice guideline that indicates ideal care of [people living with obesity],” said Dr. Marli Conradie-Smit, director of SAMMSS. “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.”

Hope for increased affordability is on the horizon. Generic versions of semaglutide are expected to enter the global market next year, with Brazil, China, and India potentially seeing the first launches. Aspen Pharmacare has indicated it will prioritize launching generic semaglutide in Canada initially, but plans to expand to South Africa as patent cycles allow.

However, patent complexities could delay generic availability in South Africa. Novo Nordisk holds 15 patents related to semaglutide in the country, and may attempt to leverage these to block generic competition. A key patent on semaglutide’s chemical compound expires in 2027, but legal challenges could prolong the wait. Generic versions of tirzepatide are further off, with key patents not expiring until the 2030s.

The market is also evolving with the development of oral formulations of semaglutide, recently approved by the U.S. Food and Drug Administration. While not yet available in South Africa, these pills could offer a more convenient and potentially more affordable alternative to injections.

This first part of a Spotlight special series highlights the challenges and opportunities surrounding GLP-1 medications in South Africa. The second installment will explore the feasibility of incorporating these drugs into the country’s public healthcare system.