Sales of glucagon-like peptide-1 (GLP-1) receptor agonists have climbed sharply in South Africa’s private healthcare sector, yet the majority of potential beneficiaries remain excluded due to prohibitive pricing and restricted medical scheme coverage. Neither the public health system nor most private insurers fully fund these treatments for obesity, despite recent clinical guidelines endorsing their use.
The class of medicines, which includes semaglutide and tirzepatide, has garnered global attention for its efficacy in reducing body weight and managing type 2 diabetes. In South Africa, Novo Nordisk’s Ozempic (approved for diabetes in 2021) and Wegovy (launched for weight management in 2025) compete with Eli Lilly’s Mounjaro, marketed locally by Aspen Pharmacare since late 2024. Data from Mediscor indicates Ozempic rose from the 170th to the 12th largest driver of medicine expenditure among medical schemes between 2023 and 2024. IQVIA data, while not publicly available, reportedly places Mounjaro as the country’s top-selling pharmaceutical product as of November 2025.
Despite escalating demand, monthly maintenance doses range from R3,000 to R6,000—an amount unaffordable for most households. Medical schemes are legally obliged to cover diabetes care but not GLP-1s specifically; access is typically contingent on stringent clinical criteria, with members often required to draw from personal savings accounts. Obesity treatment is not a prescribed minimum benefit, leaving coverage for weight-management indications largely discretionary. The South African Metabolic Medicine and Surgery Society published updated clinical guidance in late 2025 recommending GLP-1s as part of comprehensive obesity care, but acknowledged persistent reimbursement obstacles.
Patent protection remains the principal barrier to broader access. Novo Nordisk holds 15 semaglutide-related patents in South Africa; the compound patent expires in 2027, though additional patents covering formulations, doses, and delivery devices could delay generic entry. Analysts expect generic semaglutide to reach markets in Brazil, China, India, and Canada during 2026. Aspen has signalled it will introduce a biosimilar version in Canada first, with South Africa to follow based on patent expirations. Tirzepatide’s key patents are not set to expire until the 2030s, suggesting sustained exclusivity for Mounjaro.
Oral formulations of semaglutide have received regulatory approval in the United States but are not yet available locally. While the private sector experiences rapid uptake, the public sector—serving the majority of the population—does not currently supply any GLP-1 medicines. The forthcoming availability of generic semaglutide from 2027 may gradually alleviate cost pressures. However, without systematic inclusion in treatment protocols and financing mechanisms, the medicines are likely to remain accessible only to a narrow segment of patients.
