Eli Lilly Aims To Launch Foundayo In India By H1 2027 | Global Dialogues | EXCLUSIVE

Well, India is a rising part of the story. We've really sort of re-energized our business here in the last year and a half with the launch of Mounjaro, and as we brought that around the world, India's performing well in that regard. So we have high hopes for the long term to really make it amongst our top five geographies we do business in. It's coming from a low base, but a great start in 2025.

Well, that's a good question for our local team. That's why I'm here. But, yeah, we'll see. Obviously, it has the population. The incidence of diabetes and obesity is extremely high. It's a major problem here, and we have a really effective solution in the market and many more coming. So there's no reason why it shouldn't be in the next few years, but let's see. Obviously, affordability is an issue. This is not a market with insurance — mostly it's out of pocket. So we'll navigate that, but great promise here in India.

Yeah, well, we quickly became the leader in the obesity market and I think the largest selling medicine in the whole country within its first year. That's what we're very proud of — that we reached a lot of people and I think really helped them. Since we launched, though, something interesting has happened that hasn't happened in most other places, which is the introduction of generics to semaglutide, one of the competitors. So the market share is a little deceiving to look at because although that has fallen for us, it's mostly because the market expanded so dramatically with lower-priced generics. Interestingly, the Mounjaro business continues to grow in both volume and value through that event. So it does appear that consumers really are choosing the pathway that's best for them. Do they want a lower-priced entry point with less efficacy, or really a premium product with the best performance? And we've done well through that. So that's encouraging.

Yeah, well, let me start there. So we've just made a commitment this week — new news — to change the course of obesity, diabetes and cardiometabolic syndrome in low- and middle-income countries, of which India is one. Historically in our industry, we would launch new products in the most developed countries and then pretty slowly introduce them around the world, and often not even bother to get to low-income countries till 20 years after introduction. We want to accelerate all that. We feel like the scourge of obesity is a global problem. Four out of seven people with obesity globally live in low- and middle-income countries, the largest of which is India, with a quarter billion people with obesity right now. So we feel both obligated, but also it's an opportunity for us to reach all these markets. So in India, we introduced Mounjaro at a discount to the developed world. That's sort of our policy. I think what we see with the introduction of cheaper alternatives is, first of all, at those lowest price points there isn't really supply. It's a little bit of a fake signal to get attention, get in the newspaper, but certainly generics are cheaper. They don't have to pay for R&D and often don't have the same obligations for safety reporting and so forth. So it's normal, and that's part of our business cycle. Our goal is to just out-innovate that cycle. Someday Mounjaro will be generic and the price will fall when that occurs. By that time we'll have many other premium choices. So we're going to be in that for the consumer, for the doctor who's looking for something that is the latest, that is the most efficacious. Perhaps we have medicines in our pipeline that actually lose some of the GI side effects that many complain about. That's where we're focused. And at the same time, I think the market event that occurred in India was instructive for us globally. We were not sure what would happen when there's generic semaglutide available, and it turns out it doesn't really change our trajectory. So that's good news for Lilly.

Well, there are some who do supply at the higher prices because they can actually supply. So I think that all turns there today, every day, for people who are using Mounjaro and would consider switching. Very few are, I think, because they're satisfied with the performance of Mounjaro. So far, I think the experience in India is pretty positive for us in this regard, and that there's really two segments. The generics are bringing in many new consumers who wouldn't consider the out-of-pocket cost of Mounjaro and are enjoying some weight loss. If you want really the best-performing product and you're able to choose that financially, those are the consumers and the physician practices where we're doing well.

Yeah, well, affordability is a key issue. It's not actually the only issue. So one point you're raising on pricing is we have a policy, a view, that the most developed countries should pay the most, really cover the R&D cost. Low- and middle-income countries progressively less, based on income. That's sort of a concept. That's the world as we would like to see it. That's not the world as it is, in part because of cross-referencing and parallel trading that occurs and so forth. So we have to manage that as a commercial thing, but we'd like to start with that premise. But it's important to note, it's not just the price of medicines that causes a delay into Southern Africa, sub-Saharan Africa, or Southeast Asia. Often it is the regulatory systems, which are not well developed and don't accept the information we have. It can be very slow. We're committed to work through that and register products globally simultaneously. That's our goal. Here in India, we're still a little bit behind the first launches of, say, our latest medicines launched in the US. We project next year in India, but it used to take four years to get here. Now we're compressing that into one. So that's one part of this — reach the markets, get through the regulatory delays. Another is studying our medicines in these markets. So doing clinical trials in a much broader way than we ever did before. That's already underway for our pipeline medicines, and we'll continue to expand that, so the needs of patients are understood and the performance of our new medicines are understood in all populations. I think that's an important thing to do. And finally, health systems. So we can see it within India here that health systems perform differently in large urban markets from more rural markets. And sometimes just getting a diagnosis that's correct, being able to see a physician that can help you treat your condition, make you aware of new treatments — that's the biggest problem. So we're also investing in health system development through education, but also working with partners, NGOs, to reach many of these countries to help physicians and increasingly physician assistants and healthcare workers know about new solutions for treating diabetes, cardiovascular risk and obesity.

We're ready to go as soon as the Indian authorities say yes.

I think it's a big deal. I think oral will play a large part in this market. For people seeking the most powerful medicine available, it's not going to be the oral. They will lag because it's easier to make an injectable at the latest targets. But an oral gives us several other advantages. First, it's convenient. And we do know many patients are reluctant to try an injectable medicine — fear of needles, or it just doesn't fit into their daily routine. A pill seems easy, and our pill is very easy. The second is scalability. So we know in the past — we just talked about shortages of generics, but there were shortages of the branded products even in the most developed countries with the highest prices. We just couldn't make enough at one point. And it's true, if we had global access to injectable Mounjaro and it was available to everybody, we would run out. I think there's a billion people on the planet who potentially need these medicines. Our supply chain is growing, but it's not able to meet that. With an oral like orforglipron, we use chemistry and we can expand that more quickly. In fact, we have several production partners here in India which are helping us supply the globe already, and we're poised for really massive volume here. And so that's when a medicine, as you quoted me, only works when it reaches the people. A part of that is supply chain, and I think that's an important advantage here. Finally, I think being able to combine an oral with other medicines is just easier. So if you have diabetes, a lot of people take common diabetes medications. We can even imagine putting that in one package or one pill, or make it just a simple routine for people.

This week's an exciting week for us because of the European diabetes meeting, where doctors from around the world meet to talk about the latest advances. We had three really important data readouts from Lilly. These are big randomized trials. One of the ones you're mentioning is our latest invention, which is a triple-acting medicine called orforglipron/tirzepatide/zepatide, which is a combination of amycretin, which is already in phase three. That's a new medicine that promises fewer side effects, GI side effects, and excellent weight loss. We combine that with the ingredient in Mounjaro, tirzepatide, and I think it demonstrated the most profound weight loss seen so far in both people with diabetes and without. That's an earlier program. We're going to start phase three this quarter now, Q4 of this year, and in three or four years' time that'll be available globally. That's going to be exciting. We also had data on retatrutide, which is another triple-acting solution. That one has finished its trial, so we read out the latest phase data. That's going to be under review starting later this year, early next year around the world, and that's a more potent medicine than even Mounjaro to help people who need to lose even more weight. There's a lot of excitement about that one, and it will also help with diabetes. And then we also had a study on Jardiance in people with diabetes demonstrating cardiovascular risk reduction as compared to insulin. And in this study, we reduced the risk of heart attack, stroke, and CV death by more than half. So that's a very important medical finding and shows that these GLP-1 medications, these incretins — it's not just about slimming down. It's about improving your health.

Yeah, we're executing. That was a big number, and we're pulling that through. We're well on track to meet that commitment, and maybe even...