---
title: "The first generic weight loss drug has hit SA — will it be enough to kill the black market?"
description: "South Africa’s first generic semaglutide injection arrived in August, with many more expected. More competition should push down the price of blockbuster GLP-1 drugs – but will they become cheap enough to stamp out a booming black market and reach the public-sector patients who need them?"
type: "NewsArticle"
publisher: "Daily Maverick"
site: "https://www.dailymaverick.co.za"
section: "BHEKISISA"
author: "Tanya Pampalone, Mia Malan and Anna-Maria van Niekerk"
author_url: "https://www.dailymaverick.co.za/author/tanya-pampalone-mia-malan-and-anna-maria-van-niekerk/"
canonical_url: "https://www.dailymaverick.co.za/article/2026-08-24-the-first-generic-weight-loss-drug-has-hit-sa-will-it-be-enough-to-kill-the-black-market/"
published: "2026-08-24T13:24:06"
updated: "2026-08-24T15:12:54"
lang: "en-ZA"
word_count: 2804
---

# The first generic weight loss drug has hit SA — will it be enough to kill the black market?

> South Africa’s first generic semaglutide injection arrived in August, with many more expected. More competition should push down the price of blockbuster GLP-1 drugs – but will they become cheap enough to stamp out a booming black market and reach the public-sector patients who need them?

By Tanya Pampalone, Mia Malan and Anna-Maria van Niekerk · Published 24 August 2026, 15:24 SAST · Updated 24 August 2026, 17:12 SAST

## Key points
- South Africa’s first generic semaglutide (Sun Pharma/Ranbaxy) hit shelves in August and Sahpra is vetting at least 13 more applications — a price war is coming, but the first generic is only about 18.5% cheaper than Ozempic.
- A booming black market — compounding pharmacies, illicit imports and social‑media sellers — has filled the access gap, prompting raids, court fights (iDexis) and serious safety warnings about untested products.
- Researchers say generics could cost as little as R100–R200 a month to produce, yet delivery‑pen costs and market dynamics keep prices high; without state procurement, public‑sector patients will still be left out.
- GLP‑1s are rapidly reshaping care for obesity, diabetes and HIV‑related weight gain and are now on the WHO essential list — the urgent question: will policy and regulation tame prices and the black market, or will unsafe alternatives keep proliferating?

## Content

It was a carnivorous lizard with a forked tongue, sharp claws and beady skin that helped rewire the appetite of millions of people around the world, making hunger something you can switch off with a few clicks and a jab.

In the 1990s, an American [scientist by the name of John Eng](https://www.sciencedirect.com/science/article/pii/S1043661825004700) identified a molecule in the venom of the [Gila monster](https://www.nps.gov/sagu/learn/nature/gila-monster.htm), which spends most of its life underground in North American deserts. The reptile has an interesting approach to food. It emerges from the darkness just a handful of times each year to feast, and is able to maintain its blood sugar for these long stretches between meals. The molecule Eng found in the reptile acts a bit like the naturally occurring human hormone, [glucagon-like peptide-1](https://pmc.ncbi.nlm.nih.gov/articles/PMC6812410/), or GLP-1. It slows digestion, makes us feel full and steadies our blood sugar, keeping our energy steady. Eng thought it might somehow help people with diabetes.

He was right.

What [Eng unlocked paved the way for the blockbuster](https://www.sciencedirect.com/science/article/pii/S1043661825004700) drug Ozempic, which launched in 2017 in the US as treatment for diabetes, but was soon used off-label as a weight loss drug, by an insatiable public.

Financial services firms like [Morgan Stanley expect the GLP-1 market to reach $190-billion](https://www.morganstanley.com/insights/articles/glp1-weight-loss-market-may-double-190-billion-2035) (about R3.1-trillion) by 2035, more than double what it was worth in 2025.

[GLP-1s](https://nam.edu/product/health-basics-glp-1s/) have become shorthand for brand names including Ozempic, Wegovy, Mounjaro, Zepbound, Trulicity and a slew of others, with more coming as fast as pharmaceutical companies can get them into pens that deliver them in once-a-week jabs and, more recently, in tablet form. But they don’t come cheap.

At [between about R3,000 and R10,000 a month](https://bhekisisa.org/bhekisisa-tv/2026-07-08-health-beat-39-inside-sas-illegal-weight-loss-drug-trade/), Bhekisisa’s TV programme, Health Beat, reported in July, depending on the type and amount of medication a patient needs, even those pulling down R1-million annual salaries struggle to pay for it.

Those prices will start coming down now.

In March, [patents on semaglutide](https://www.iqvia.com/locations/emea/blogs/2025/07/off-patent-semaglutide#1), the ingredient that makes Ozempic and Wegovy work, expired in several countries, opening up the generics market to millions. Earlier this month, Sun Pharma launched [the first generic semaglutide injection](https://bhekisisa.org/wp-content/uploads/2026/08/Sun-Pharma-Semaglutide-Launch-Announcement-in-SA.pdf) for type 2 diabetes in South Africa via its local subsidiary, Ranbaxy. And the South African Health Products Regulatory Authority (Sahpra) says they are now looking at 13 more applications from companies ready to sell generics here.

![Bhekisisa-semaglutide jab](https://cdn.dailymaverick.co.za/i/JUatb_O5BrrAFlPHoWMDNzb8Czc=/200x100/smart/filters:strip_exif\(\)/file/attachments/orphans/Howmuchlessdoyoupayforthegenericcopy_875050.jpg)

The question is: will generics bring down the price low enough to take down an illegal market that has grown up in the price gap and get the medication to the people who need them the most?

### ‘This is not a vitamin’

A former professional athlete who spoke with [Health Beat](https://bhekisisa.org/bhekisisa-tv/2026-07-08-health-beat-39-inside-sas-illegal-weight-loss-drug-trade/) on condition of anonymity, said she bought into the GLP-1 black market trade in 2023 after gaining 30kg and becoming pre-diabetic following a trauma that had her on [antidepressants, a common side-effect](https://pmc.ncbi.nlm.nih.gov/articles/PMC12121960/) of which is weight gain.

The 38-year-old tried everything she could to take off the extra kilos – eating healthy, limiting her food intake, exercising and drinking all kinds of protein shakes in an attempt to stave off hunger. Despite all of that, she says, her weight wouldn’t budge.

Ozempic had arrived on the South African market by then, and her doctor gave her a script. But when she went to the pharmacy to pick it up, they were out of stock. At the time there was a global shortage of the medication driven by massive demand and, in [South Africa, people could wait weeks to fill their prescriptions](https://bhekisisa.org/article/2023-02-09-ozempic-a-hashtag-a-helpful-effect-collide-drain-global-stocks-of-a-diabetes-drug/).

She found a compounding pharmacy that was willing to sell it to her with the script from her doctor. These types of pharmacies are [licensed to mix medications](https://www.gov.za/documents/medicines-and-related-substances-act-regulations-general-25-aug-2017-0000) specifically prepared for an individual, and prescribed by a doctor – for example if a person isn’t able to take a medication in, say, a tablet form and needs it in a liquid version. Having a licence to compound medicines, doesn’t mean a pharmacy can compound whatever medicine they’d like to. [Instead the law sets out specific rules](https://www.gov.za/documents/medicines-and-related-substances-act-regulations-general-25-aug-2017-0000), and a mere shortage of a medicine alone isn’t enough by itself to justify compounding it.

The cost for her [semaglutide](https://www.sahpra.org.za/faqs-semaglutide/) was R2,500 a month, slightly less than she would have paid for the real thing.

Within days of taking it, the noise stopped. She eventually lost 10kg and started boxing again. “It was so amazing not to be starving for the first time in years,” she says. Then she heard about another type of GLP-1, [retatrutide](https://www.lilly.com/news/stories/what-to-know-about-retatrutide), and went back to the doctor. Word had it that she could lose even more – up to 30% of her body weight.

Retatrutide studies have indeed shown [those kinds of impressive numbers](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736\(26\)00967-0/abstract). The drug targets three hormones instead of the one semaglutide homes in on, or the two hormones [tirzepatide](https://www.mdpi.com/1420-3049/27/13/4315), which is marketed as Mounjaro or Zepbound, are directed at. The thing is, retatrutide is still in its trial phase. It has not been approved for use anywhere in the world, other than an [allowance made early in August](https://www.statnews.com/2026/08/03/eli-lilly-retatrutide-mystery-patient-doctors-seek-same-access-their-patients/) by its maker, Eli Lilly, to treat obesity in a select number of patients, with special permission, in the US.

The former athlete’s doctor had her sign a waiver to get the medication, explaining that because the drug was still in the trial phase he would need to be released of any responsibility for what might go wrong. And things could have gone very badly.

“The moment I signed this disclaimer, I thought, this is not a vitamin, this is an experimental drug,” she says. She paid the doctor R3,000 for a month’s supply, and he gave it to her in his office, saying he had it tested to make sure the compound actually had retatrutide in it. “That is why I wanted the tested one, even though I would pay more for it.”

That testing, says [Francois Venter](https://www.ezintsha.org/leadership/francois-venter/), the head of Ezintsha, the health research unit at the University of the Witwatersrand, would require having a “Breaking Bad person in your back pocket” – that is, your very own biochemist to test the stuff before it goes into your body. While that doctor may have been able to get his compounded version tested by his own [Walter White](https://interviews.televisionacademy.com/shows/breaking-bad?chapter=2&clip=87329), it wouldn’t make it any more legal – or safe – for him to supply an unregistered medicine.

“I get the impatience,” Venter told [Health Beat](https://bhekisisa.org/bhekisisa-tv/2026-07-08-health-beat-39-inside-sas-illegal-weight-loss-drug-trade/). “But the level of risk \[people taking the illegal medications are\] putting themselves at makes me very worried. I think this is testament to how medicine has failed in terms of getting these drugs to people at an affordable price.”

Advocates are hoping the wave of generics will help drive prices down so the drugs aren’t just a costly decision for those who have the cash to get them. Medical aids[don’t have to cover GLP-1s](https://www.medicalschemes.co.za/resources/pmb/pmb-conditions/) for weight loss because obesity is not a prescribed minimum benefit condition, and only in select cases will they cover them for type 2 diabetes.

What activists are banking on is that lower costs of generics will help convince the government to approve the medications as an option for the [84% of South Africans dependent on public healthcare](https://bhekisisa.org/article/2017-08-08-does-sas-private-healthcare-sector-only-provide-care-for-16-of-the-population/).

### Whack-a-mole

The eye-popping price tag is a major factor driving the black market trade. Like the former athlete, many people are getting their hands on GLP-1 medications through [compound pharmacies, which are prohibited](https://www.sahpra.org.za/wp-content/uploads/2019/09/Medicines-and-Related-Substances-Act_101-of-1965_Act_GG-40869_2017-05-26.pdf) from large-scale manufacturing, advertising or distribution of unregistered medicines.

According to Sahpra’s chief executive, Boitumelo Semete-Makokotlela, the agency’s whistleblowing platform gets two or three complaints a week about unregistered GLP-1s advertised on WhatsApp, Facebook and X. Because these are [schedule 4 medications](https://www.gov.za/sites/default/files/gcis_document/201409/medicines0.pdf), advertising the doctor-prescribed drugs to the public is illegal, even if they are registered.

“When there’s a complaint, we send inspectors to investigate and inspect the product. If noncompliant, we confiscate the products. Where there’s an e-commerce platform, we bring down the site. That’s a tough one to do,” she says of its whack-a-mole strategy. “You close down one site today, and another one emerges.”

In May, [Sahpra and the South African Pharmacy Council raided iDexis](https://www.sahpra.org.za/wp-content/uploads/2026/05/SAHPRA-CRACKS-DOWN-ON-UNLAWFUL-MANUFACTURING-OF-UNREGISTERED-GLP-1-MEDICINES_May20_RB_FINAL_May23.pdf), a Pretoria-based compounding pharmacy. They seized compounded versions of semaglutide, tirzepatide and other untested GLP-1 weight loss combinations that, they say, were being manufactured and marketed for broad commercial sale.

Novo Nordisk, the company that owns Ozempic and the patent for semaglutide until it expired in South Africa, obtained a [temporary interdict on the company in June](https://bhekisisa.org/wp-content/uploads/2026/08/CCF_000450.pdf). The judge instructed iDexis to cease making and selling the knock-off version, pointing to the [Medicines Act](https://www.sahpra.org.za/wp-content/uploads/2019/09/Medicines-and-Related-Substances-Act_101-of-1965_Act_GG-40869_2017-05-26.pdf) that only allows compounding with “the same” ingredient, not merely a similar one that is unregistered by Sahpra. IDexis was also dispensing the compounded semaglutide on a huge scale – up to 84,500 patients per month, according to [court documents](https://www.saflii.org/za/cases/ZAGPPHC/2025/393.html)– and not for a few patients with prescriptions, as the law requires.

“I’ve been in the industry for 40 years, and I haven’t seen an explosion of compounded medicines like this,” says Stavros Nicolaou, head of strategic trade at Aspen Pharma, who says he believes the iDexis figure is far higher than 84,500. [News24 reported](https://www.news24.com/southafrica/news/ex-blue-bulls-doctor-detained-after-china-trip-amid-crackdown-on-slimming-injections-20260530-1012) that iDexis’s managing director, Ruaan Louw, told the publication his company had processed more than 200,000 prescriptions for GLP-1s by the end of May. “This is a scale beyond belief, to be honest,” says Nicolaou.

Knock-off versions of GLP-1s are being brought in as cat food or calcium, he says, avoiding detection by authorities. Compounding pharmacies, who are mixing the medications in South Africa, are one way people are getting the medications; others are finding knock-offs or products still in trial on the black market and having them shipped from overseas.

The danger is that nobody really knows what they are putting in their bodies.

“You cannot determine, evaluate or confirm where it’s being made, whether the product is being made under good manufacturing conditions or whether it actually even contains the active ingredient… if it has too much or too little of it or whether the product’s contaminated. So, in many instances you pick up contaminated products or products that are underdosed or overdosed, and then patients land up in ICU,” Nicolaou told [Health Beat](https://bhekisisa.org/bhekisisa-tv/2026-07-08-health-beat-39-inside-sas-illegal-weight-loss-drug-trade/).

The retatrutide formulations are even more of a risk. “Even if a medicine has shown potential… you still have to complete all the clinical trials, so that you can ensure that (a) the product is \[effective\], and (b) it’s safe for patients to take.”

Semete-Makokotlela says a legal product is easy to spot: it carries a Sahpra registration number and a patient information leaflet listing any warnings or side-effects. In an effort to combat the illegal GLP-1 market, the agency has embarked on an awareness campaign, including [public facing information](https://www.sahpra.org.za/peptide-products-public-information/) to help consumers know what to look out for.

### Where obesity meets HIV

Even if people all around the world are doing whatever it takes to get their hands on any form of the medication – in the US, [authorities have tried to crack down](https://www.fda.gov/drugs/drug-alerts-and-statements/fda-clarifies-policies-compounders-national-glp-1-supply-begins-stabilize), but [it’s still easy to](https://www.nytimes.com/2026/06/18/well/retatrutide-peptide-weight-loss-black-market.html) buy a compounded version at your local medical spa with your Botox or through massive telehealth platforms such as [Ro](https://ro.co/lp/weight-loss/quiz/) – it still can’t keep pace with the [global obesity epidemic](https://www.who.int/activities/controlling-the-global-obesity-epidemic).

A [study in the journal Nature in May](https://www.nature.com/articles/s41586-026-10383-0), which drew on more than 4,000 studies of 232 million people, found that obesity has plateaued or even edged down in most wealthy countries. But it is climbing in the developing world.

“Our obesity problem is actually worse than the United States, and we haven’t peaked yet,” Venter says. According to a 2025 study published in the [South African Medical Journal](https://samajournals.co.za/index.php/samj/article/view/4015/1930?), obesity rates in the country rose substantially between 1998 and 2017. Those numbers are particularly high among women, where rates shot up from about 30% to 43%.

Obesity is classified as a [chronic disease by the World Health Organization (WHO)](https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight). It can lead to heart disease, diabetes, different types of cancers and even brain disorders. The WHO has [added GLP-1s for the treatment of obesity to its essential medicines list](https://www.who.int/news/item/01-12-2025-who-issues-global-guideline-on-the-use-of-glp-1-medicines-in-treating-obesity) and issued guidelines on their use in obesity, alongside healthy diets and exercise, a signal that the drugs are no longer seen as a luxury.

In addition to weight loss and controlling diabetes, studies are consistently showing [other remarkable benefits](https://www.researchgate.net/publication/388193604_Mapping_the_effectiveness_and_risks_of_GLP-1_receptor_agonists). Among others, researchers have found it can reduce [heart attacks and strokes](https://www.nejm.org/doi/pdf/10.1056/NEJMoa2307563); [heart, kidney](https://www.thelancet.com/journals/landia/article/PIIS2213-8587\(24\)00271-7/abstract) and [liver](https://www.nejm.org/doi/10.1056/NEJMoa2413258?) diseases; [sleep apnoea](https://pmc.ncbi.nlm.nih.gov/articles/PMC11598664/), a [condition that causes](https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631) breathing to stop and start during sleep; and may even help [ease drug and alcohol addictions](https://www.bmj.com/content/bmj/392/bmj-2025-086886.full.pdf). [Side-effects](https://jamanetwork.com/journals/jama/fullarticle/2810542) like nausea, diarrhoea, vomiting and constipation are the most common, but some researchers have raised concerns about [gallbladder disease](https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2790392). And, as the weight peels off, [so does muscle mass and bone density](https://communityhealth.mayoclinic.org/featured-stories/weight-loss-drugs), making weight-bearing exercises crucial, which is even more important for older patients.

Still, Venter says the drugs are nothing short of revolutionary. Particularly for South Africa’s other epidemic: HIV. He says weight gain is the biggest challenge in HIV care now. A [Johannesburg-based study he led](https://www.sciencedirect.com/science/article/abs/pii/S2352301820302411?utm) showed that patients on the latest antiretrovirals (ARVs) gained weight, sometimes dramatically.

In a [recent op-ed for Bhekisisa](https://bhekisisa.org/opinion/2026-07-24-what-hiv-got-right-but-obesity-still-hasnt/), Venter and his colleagues describe a woman at a Johannesburg clinic who gained weight she couldn’t lose after starting on ARVs. She kept buying bigger and bigger clothes and blaming herself. But the story that weight loss comes down to discipline is just not true, he says.

“They’re told it’s simply a moral failure, that you just eat badly and don’t exercise enough, and if you suck it up and do the right thing you can \[lose the weight\] through sheer will,” he says. “That is absolute nonsense. There’s a tiny percentage of people who can lose weight that way, and they’re the ones who go on television and write bestsellers and sit around the dinner table and shame everybody. But for the vast majority of us, our weight just steadily goes up.”

Taking GLP1-s means a lifetime commitment – it’s not a quick fix weight loss strategy. Those who go on the medications and then [stop them will gain a lot of the weight](https://pmc.ncbi.nlm.nih.gov/articles/PMC9542252/) back. It’s a continual investment that makes the high cost even more painful.

### The coming wave

According to Venter, it shouldn’t be that way.

He co-authored a study [published in the journal Obesity](https://pmc.ncbi.nlm.nih.gov/articles/PMC13422654/) in July, which cost the production of semaglutide. Venter says generics could be manufactured at about R100 to R200 for a month’s supply. The biggest cost, the researchers found, is the pen that delivers the injectable drug, which alone can cost between eight and 68 times more than semaglutide and all other production costs combined.

Nicolaou says generic pricing usually starts between 25% and 30% below the brand cost but that prices normally continue to drop as more players enter the market. But when Bhekisisa phoned a national pharmacy chain for the price of Ranbaxy’s generic product, we found the generic, Semagard, is only about 18.5% cheaper than Ozempic.

And with 13 more applications for semaglutide with Sahpra and 18 for an earlier GLP-1 drug, [liraglutide](https://www.mayoclinic.org/drugs-supplements/liraglutide-subcutaneous-route/description/drg-20073828), [with at least one](https://pi-pil-repository.sahpra.org.za/wp-content/uploads/2025/11/Final_PIL_GILIPTRA_Applicant.pdf) of those already on the market, it is a good sign for those who want to see the price drop quickly.

![Bhekisisa-semaglutide jab](https://cdn.dailymaverick.co.za/i/fwbHIdE1dsVS5_iGKxudgofPE1o=/200x100/smart/filters:strip_exif\(\)/file/attachments/orphans/Howmuchdosemaglutideproductscostcopy_734614.jpg)

Aspen hopes Sahpra will approve its application for a generic product soon, which, according to Nicolaou, will initially import its generic semaglutide made at an Aspen facility outside of South Africa, and then start making it locally.

Meanwhile, Novo Nordisk recently brought out [Extensior](https://www.reuters.com/legal/litigation/novo-nordisk-launch-lower-cost-ozempic-copy-south-africa-2026-07-17/), a cheaper version of Ozempic, which costs about 15% less. Earlier this year, the company [dropped prices for Wegovy](https://www.reuters.com/sustainability/boards-policy-regulation/novo-nordisk-cuts-wegovy-price-south-africa-second-time-2026-03-25/), its version of semaglutide specifically for weight loss. While that might be good news for those who are already buying it, it’s still stratospheric to most.

“They are simply unaffordable, and they are not expensive to make,” says Venter. “It’s pharma greed and the government just sitting on its hands. We have incredibly good people in government who could be pushing this forward, who did an amazing job with ARVs for HIV treatment. I don’t understand why we’re not pushing harder on this.”

For now, the woman at the Johannesburg clinic who put on weight after starting HIV treatment will have to wait for the medications that might help her stave off chronic disease from obesity. Dependent on public healthcare, she doesn’t have that option. So even if Sahpra approves all of the generic GLP-1 applications, the cheapest one in the world will change nothing for her unless the state chooses to buy it. **DM**

*Some of the reporting on this story is from*[*Bhekisisa’s television programme, Health Beat*](https://bhekisisa.org/bhekisisa-tv/2026-07-08-health-beat-39-inside-sas-illegal-weight-loss-drug-trade/)*.*

*This story was produced by the*[*Bhekisisa Centre for Health Journalism*](http://bhekisisa.org./)*. Sign up for the*[*newsletter*](http://bit.ly/BhekisisaSubscribe)*.*

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