As many as 1.5 million patients in the United States may now be using compounded versions of popular weight-loss drugs, highlighting how lower-cost alternatives have rapidly filled gaps left by expensive branded treatments, according to the chief executive of Novo Nordisk.

Speaking at the J.P. Morgan Healthcare Conference, Novo Nordisk CEO Mike Doustdar said compounded versions of GLP-1 drugs have gained traction among patients priced out of approved medicines for obesity, a development the company underestimated early on, according to a Reuters report.

Doustdar said compounders were quicker to respond to consumer demand, offering monthly prices of around $199, far below the cost of branded GLP-1 medications such as Wegovy, which 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,” Doustdar said. “They grabbed a part of the consumers that simply were price sensitive to the whole thing.”

Novo Nordisk, which has repeatedly warned about the safety risks of compounded and counterfeit GLP-1 products sold online, distinguishes between legitimate telehealth providers and what it describes as sellers of unsafe knock-off drugs. Doustdar said the company continues to challenge the sale of counterfeit products that bypass regulatory safeguards.

Earlier this month, Novo launched a daily oral version of Wegovy in the U.S. with a starting cash price of $149 per month, aimed at consumers without insurance coverage and at reclaiming market share from compounders.

Doustdar acknowledged that the surge in compounded GLP-1 use has become a key lesson for Novo as it reassesses pricing, access, and speed in the increasingly competitive obesity drug market.

Since taking over as CEO in July, Doustdar has overseen a sweeping restructuring at the Danish drugmaker, including plans to cut 9,000 jobs globally, arguing that rapid execution is essential in a fast-moving industry.

“Unless you’re speedy, someone else takes your breakfast,” he said, defending the pace of change.