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Avikli’s price for the disposable FlexTouch pen of 700 units will be Rs 2,611, which is approximately Rs 37.8 per unit.
The company launched Avikli in India on Thursday – which is derived from the word “weekly” – and the drug is expected to be available in pharmacies from Friday, July 10. (AI generated image)
For a person with diabetes, the day often starts with a needle – he or she needs at least 365 shots of insulin a year. Danish drugmaker Novo Nordisk has found a way to reduce that number to just 52 with the launch of the world’s first “once a week basal insulin.”
The company launched Avikli in India on Thursday – which is derived from the word “weekly” – and the drug is expected to be available in pharmacies from Friday, July 10.
Vikrant Shrotriya, Managing Director, Novo Nordisk India, told News18 in an exclusive interview that, “The launch of Avikli is an important moment for the company,” he said. “Instead of 365 injections a year, to start the insulin insulin, one would have to take just 52 injections.”
The company has launched Avikli at Rs 2611 for 700 units, claiming that the price is on average 25 to 35 percent cheaper than modern second-generation insulins.
With more than 100 million diabetic patients and another 130 million pre-diabetic patients, India is one of the largest markets for the Danish drugmaker. “It’s in the top 10 – I don’t shy away from saying that,” Shrotriya said of India’s importance to Novo Nordisk globally. He pointed to the company’s manufacturing and R&D presence in Bengaluru, its foundation office at IIT Delhi and its regional holding office in Mumbai’s Bandra-Kurla Complex as evidence of its long-term commitment beyond commercial business.
How is once a week insulin important for India?
Shrotriya believes that this insulin solves the problem of reluctance and hesitation in taking human insulin. Despite a century of insulin therapy and several generations of refined molecules, India still struggles to get insulin to patients when they need them and keep them there. “Despite the availability of so many treatments, so many treatments, we still don’t have ideal HbA1c control of glucose,” he said. “Primarily, one reason is that people refuse to take insulin early on. By the time they take insulin, it’s 8 or 9 years too late. It’s been studied that 93 percent of patients will not want to take insulin injections, and in fact, even physicians have this hesitancy.”
Shrotriya warns that the delay is no small matter. By the time many patients finally begin insulin therapy, he said, about half of the beta cells that naturally secrete the hormone have already been destroyed — a quiet, irreversible cost of procrastination that involves both patients and doctors.
The numbers support that. Data from the National Family Health Survey-6 (2023-24) shows that 20.9 per cent of Indian males aged 15 and above now have high blood sugar or are taking medication for it, up from 15.6 per cent in the NFHS-5 (2019-21) a few years ago. Among women, this figure has increased from 13.5 percent to 17.8 percent over the same period. More than 101 million people in India already suffer from diabetes, and another 136 million are just one step away from prediabetes – a population large enough to reshape the country’s public health priorities for a generation.
what actually happens inside the body
The science behind Avikli is based on a discovery from the 1950s, when scientists including Frederick Sanger, who first sequenced the amino acid structure of insulin, opened the door to modifying the hormone rather than just its distribution. According to Shrotriya, Novo Nordisk changed three amino acid positions on the insulin chain and added a fatty acid at one end – changes that extended the drug’s effective half-life to more than 190 hours. That modified molecule binds reversibly to albumin, a protein in the blood, and is released slowly over days rather than hours, allowing a single injection to cover an entire week.
“Time in range, that means insulin coverage is very good. HbA1c control is very good,” Shrotriya said.
The claims are based on the ONWARDS clinical program, six Phase 3A trials that studied more than 4,000 patients globally, including participants in India. Novo Nordisk says all six trials met their primary endpoints, and without any additional safety compromises, Avikli demonstrated better HbA1c reduction and range improvement than once-daily glargine U100.
Pricing: The part that decides India’s story
Innovation is one thing, but adapting it to a price-sensitive market like India is quite another, and Shrotriya made it clear that the company has learned this lesson in its four decades of operating in the country. Avikli will be priced at Rs 2,611 for the disposable FlexTouch pen of 700 units – which is approximately Rs 37.8 per unit.
“You would be surprised, and this is a moment of joy, that it is actually 25 percent cheaper on average than modern second-generation insulin,” Shrotriya said, later in the conversation revising this figure to as high as 35 percent compared to some comparables. “We want early initiation of insulin, and we personally believe that when it is given it changes the lives of many patients.”
This strategy, he said, repeats what the company did with Ozempic-branded semaglutide: Lower the price, and adoption will build. “What we learned from semaglutide is that we lower the price and increase access,” he said. “This is a very excellent example.”
Who should really make the switch?
Shrotriya was careful not to position Avikli as a blanket replacement for every patient on insulin today. The decision depends entirely on the treating physicians, he said. “They should have their close physician and a diabetes specialist who can prescribe,” he said. “If their glucose is not controlled, and in diabetes, usually from time to time, patients go to the doctor — if the doctor prescribes, they can take advantage of this drug.”
Benefits and Side Effects: Experts
According to Dr. Anup Mishra, Executive Chairman, Fortis C-DOC Hospital for Diabetes and Allied Sciences, “Once a week basal insulin is a significant advancement in diabetes care.”
“It may reduce the burden of daily injections and improve treatment adherence in appropriately selected adults with type 2 diabetes who require basal insulin. Careful patient selection, education, and dose titration are essential to ensure safe and effective glycemic control.”
Similarly, Dr Ambrish Mithal, Group Chairman, Endocrinology and Diabetology at Max Hospital, believes that the launch of Avikli is a significant advancement in the country’s arsenal against diabetes. “Basal insulin does not take care of meal-related spikes. Insulins such as glargine mimic basal insulin secretion and are classically given once every 24 hours. Giving larger doses once every seven days is a very significant advance. The advantages are convenience and better adherence, as people are more likely to be willing to commit to treatment and follow-up. It also becomes easier to persuade patients to start insulin therapy.”
The downside, he explained, is that we can’t micro-adjust the dose as we can with daily basal insulin. “If a patient develops hypoglycemia, it may last a long time because once insulin is given you cannot stop it. This will require significant training for doctors and diabetes educators. In the beginning, there may be some challenges.”
Another challenge is missed doses, Mithal said. “Managing a missed weekly dose is more complex, and cannot be corrected as quickly.”
Overall, experts believe that this is a good progress and is welcome. It is mainly for people with type 2 diabetes whose blood sugar is not controlled by oral diabetes medications. Many patients are reluctant to start insulin, but once a week injections may be much easier for doctors to convince them.
Beyond insulin: what else is coming?
Shrotriya shared a glimpse of Novo Nordisk’s broader India pipeline, which extends beyond diabetes. The company has applied for approval of its oral GLP-1 formulation, Wegovi Pill, in India, though he cautioned that its launch is still some way off. Also in development are cagrilintide-semaglutide for weight management, a treatment for both obesity and cardiovascular risk, once-weekly growth hormone therapy for growth hormone deficiency, and an upcoming treatment for sickle cell disease.
On semaglutide losing patent protection in India in March this year, Shrotriya dismissed any suggestion that the company was seeing a “dry” revenue trend despite the entry of generic competition into the market. “I think we’re growing sequentially, month-over-month,” he said, crediting the company’s completely in-house supply chain — from active ingredient to needle — for maintaining physician and patient trust even as generic drugs rise. They reported that even a year after the launch, less than 1 percent of India’s eligible population has received semaglutide-based treatment, while 250 million people are classified as overweight, 350 million people with central obesity, 100 million people with diabetes, and 130 million people with impaired glucose tolerance.
About the author
Himani Chandna, Senior Associate Editor, CNN-News18, covers healthcare, pharma and medical research, bringing clarity to complex science and policy.
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