Generic semaglutide is here: what it could mean for Barbados

Barbados: a formulary promise and a price problem

In March 2026, during the budget debate, Prime Minister Mia Mottley told Parliament that weight-loss medication belongs on the Barbados National Drug Formulary: "We are of the view that it makes sense for us to put it on the formulary", she said, adding that it was not in that year's budget but "it is already committed to in the manifesto"¹. Formulary medicines are free for people aged 16 or under, 65 or over, or diagnosed with conditions including diabetes and hypertension², so cost to the State is the central question. The need is large: the national Health of the Nation survey found obesity in 33.8% and diabetes in 18.7% of adults aged 25 and over³.

WHO has named price as the main barrier. When it added semaglutide, dulaglutide, liraglutide and tirzepatide to the Essential Medicines List in September 2025, it said that "high prices of medicines like semaglutide and tirzepatide are limiting access" and listed "encouraging generic competition to drive down prices" as a key step¹⁰. Its December 2025 obesity guideline projected that GLP-1 therapies would reach "fewer than 10% of those who could benefit by 2030"¹¹.

India, Canada, Brazil: where semaglutide went generic

Health Policy Watch reported that semaglutide's core patent expired in March 2026 in India, China and Brazil, while secondary patents protect the brand in the United States and Europe until around 2031–2032⁸. In India, Business Today named seven companies launching generics a day after the patent expired; Novo Nordisk's Wegovy had cost Rs 10,850–16,400 a month after a 37% cut in November 2025, and generic prices fell "as much as 90%" from the brand⁴.

In Canada, Dr Reddy's said on 29 April 2026 it was the "first company to receive approval from Health Canada for its generic semaglutide injection", for adults with type 2 diabetes; Apotex announced its own approval on 1 May⁵. Apotex launched on 14 May and Dr Reddy's on 16 May, with Teva, Aspen Pharmacare, Taro and Sandoz applications under review⁶. In Brazil, the national pharmacists' council reported that Anvisa approved EMS's generic semaglutide pen in August 2026, indicated for type 2 diabetes and, at specific doses, obesity; EMS had not announced a price⁷.

WHO prequalification: a quality stamp for generics

On 11 May 2026, WHO invited manufacturers of semaglutide injection, alongside insulins, to submit an expression of interest for prequalification⁹. As Health Policy Watch explained, prequalification "does not re-evaluate whether semaglutide works or is safe"; it checks whether a specific manufacturer meets quality standards, so procurement agencies can rely on that assurance⁸. For a small public buyer such as Barbados, a prequalified product could reduce the work of judging an unfamiliar generic maker.

What the Barbados Medical Products Act, 2026 allows

The new Act, which comes into force by Proclamation, sets out the routes a generic would take in Barbados¹²:

• Generic standards. The Authority may set standards for "interchangeable multi-source medicines, otherwise known as generic equivalents" and for relying on other regulators' assessments (section 44(2))¹².
• Accelerated registration. A product approved by a stringent regulatory authority on the list the Authority publishes under section 57 is handled through a mutual recognition procedure (section 45)¹².
• Parallel import. An unregistered product may be registered for parallel import if it is identical or sufficiently similar to one registered in Barbados; a generic must be bioequivalent to the reference product, and permits go only to holders of a wholesale distribution licence (section 46)¹².
• No grey market. Nothing may be imported, sold or advertised without registration and marketing authorisation (section 43)¹².

Which generic semaglutide, if any, reaches Barbados will depend on these regulations and on the stringent-authority list, which the Authority has yet to publish because the Act is not yet in force¹².

What generics do and do not change for prescribers

The early generics are approved for type 2 diabetes⁵⁶⁷, the indication where semaglutide has outcome data: in SUSTAIN-6, among 3,297 patients with type 2 diabetes at high cardiovascular risk, the primary cardiovascular outcome occurred in 6.6% on semaglutide versus 8.9% on placebo (hazard ratio 0.74), although retinopathy complications were higher¹³. Weight-loss use of a diabetes-labelled generic would raise the same off-label questions as the brand. Cheap generics are also not the same as cheap online vials: test purchases from illegal websites found semaglutide purity of 7.7% to 14.37%¹⁴.