SAN FRANCISCO, California: Danish pharma major Novo Nordisk is reassessing how it prices and markets its obesity drugs after discovering that a large pool of U.S. patients has turned to cheaper, unapproved alternatives, a shift its CEO says the company was slow to anticipate.

Speaking at the J.P. Morgan Healthcare Conference, Mike Doustdar said as many as 1.5 million patients in the United States may now be using compounded versions of popular GLP-1 weight-loss drugs, highlighting how demand has spilled beyond branded medicines.

Compounders were quicker to respond to what consumers wanted, Doustdar said, particularly among patients unable or unwilling to pay for branded treatments from Novo Nordisk and rivals.

Novo, the maker of the obesity drug Wegovy, has repeatedly warned about the safety risks associated with compounded and knock-off GLP-1 drugs, many of which are sold online and marketed directly to consumers. But Doustdar acknowledged that pricing played a decisive role in their uptake.

Many patients, he said, were drawn to compounded GLP-1s priced at around US$199 a month, compared with branded products that can cost several hundred dollars without insurance coverage. "It's not because this one-and-a-half million patients like to have unsafe, knock-off versions of our products... they (compounders) grabbed a part of the consumers that simply were price sensitive to the whole thing."

Earlier this month, Novo launched a daily oral version of Wegovy in the U.S. at a starting cash price of $149 per month, aiming to attract patients without insurance coverage and regain momentum in an increasingly competitive weight-loss market.

Doustdar stressed that Novo supports legitimate online pharmacies and telehealth providers but draws a sharp line between them and sellers offering counterfeit or unsafe products.

"There is this surprising element of a group of companies being able to pass FDA, come and sell unsafe, knock-off products in this market," he said, adding that Novo continues to fight against such practices.

The widespread use of compounded drugs — effectively copies of branded medicines — has become a key lesson for Novo as it rethinks access and pricing strategies for its obesity portfolio, he said.

Since taking over as CEO in July last year, Doustdar has moved quickly to reshape the company, launching a sweeping global restructuring that includes cutting 9,000 jobs across departments and regions.

He defended the pace of change, saying the competitive environment left little room for hesitation. His experience running Novo's international business reinforced how quickly rivals can move in fast-growing markets. "Unless you're speedy, someone else takes your breakfast."

Doustdar added that his 33 years at Novo Nordisk allowed him to act faster than an external hire, because he already understood where changes were needed, a familiarity he said was crucial as the company adapts to a weight-loss market being reshaped by affordability, access, and intense competition.