Bloomberg长篇报道巴西GLP-1灰色市场：走私与复方药规模庞大，司美格鲁肽仿制药已上市

When Ana Paula Oliveira decided she wanted to get thinner with weight-loss injections, her doctor told her no.

Her physician said she didn’t meet the clinical criteria for a prescription, which is required in Brazil for the body-slimming GLP-1 drugs. But Oliveira, who has never been obese, said she felt pressure because all of her friends across Sao Paulo and colleagues at one of the country’s major banks were shedding pounds with medicines like Eli Lilly & Co.’s Mounjaro.

“You start to feel fat even when you’re not,” Oliveira, 33, said in an interview.

So she found another route, across the border.

Oliveira buys a Paraguayan brand of tirzepatide, the active ingredient used in Mounjaro, through a reseller she contacts on WhatsApp. She doesn’t know how the medication makes its way from Paraguay to Sao Paulo, only that it is delivered to her office via an Uber courier. She pays about 1,800 reais (about $360) for a 60-milligram vial, enough to last her about six months at the minimum dose. That’s a fifth of the pharmacy price for Mounjaro.

Around the world, demand for obesity drugs is booming. The global market is projected to top $200 billion in the next decade, reshaping not just waistlines but insurance costs, grocery aisles, clothing styles and even the airline industry.

Brazil’s beauty-obsessed culture has long made it a hotbed for cosmetic treatments and plastic surgery. Now it’s the second-largest market for GLP-1 medications. One in three Brazilians is interested in taking the drugs if the price were lower, according to retail analytics company Scanntech, but most can’t afford them or don’t qualify for a prescription. A one-month supply of Mounjaro at the minimum dosage costs about 1,500 reais, roughly the same as a month of minimum-wage pay.

This has led to a booming underground trade that has grown alongside Brazil’s appetite for weight-loss medicines, inciting a wave of crime and endangering the health of millions of people. India, the US and Europe have also dealt with counterfeits and illicit sales, but the unofficial market in Brazil is unique in its scale and acceptance.

There’s little stigma around how people get their hands on weight-loss drugs in Brazil. Many buy the drugs online or through friends and family, with no medical oversight. They talk about the purchases openly, with little concern for the health risks or origins of the shots.

Gabriela, a 29-year-old nanny who lives about 45 minutes outside of Brazil’s capital, said she was overweight but nervous to try a GLP-1 injection. After seeing a friend benefit from the Paraguayan version, she got the contact information for her reseller. The tirzepatide vials arrive on ice, sealed in a foam container, and cost about 700 reais for a month’s supply. Gabriela, who asked to be identified by only her first name to discuss her health, said she lost 25 kilograms (55 pounds) in five months. She has referred her mom and friends to the reseller, who will sometimes run promotions for buying in bulk.

“It’s become a craze.”

“People see the change, you know?” she said. “Then they ask me for her number. And I ended up referring a lot of people to her, a whole lot. It’s become a craze.”

Prescriptions filled at pharmacies aren’t expected to be the biggest source of GLP-1s in Brazil this year. Outside of drugstores, sales are expected to reach almost 19 billion reais ($3.7 billion) this year, according to estimates from Itaú BBA. Of that, about 6.5 billion reais is estimated to come from products purchased in Paraguay that are illegally diverted into Brazil, bypassing the country’s regulated pharmacy system. The remainder is mostly supplied by compounding pharmacies that custom mix tirzepatide.

Lower-priced generic versions of the active ingredient in Ozempic have recently come on the market, but they require a prescription.

Even with the introduction of generics, Itaú BBA estimates that compounded versions of GLP-1s and Paraguayan tirzepatide could still account for 43% of a GLP-1 market that’s expected to reach 61 billion reais by 2030.

“The use of these pens is underestimated because many low-income families and individuals, despite the significant risks involved, have been turning to an unregulated parallel market that is difficult to track,” said Claudio Felisoni de Angelo, a professor at the University of Sao Paulo.

Path from Paraguay

At first, Oliveira asked a relative who lives in Paraguay to bring her Tirzec, a brand of tirzepatide manufactured by Paraguayan drugmaker Quimfa SA and sold as an injectable solution in vials. It’s legal in Paraguay but isn’t registered with Anvisa, Brazil’s health regulator. When the supply ran out, Oliveira tracked down an online reseller, who had it delivered via Uber.

In a statement, Uber Technologies Inc. said its Uber Connect package delivery service “does not allow the shipment of items whose transportation is prohibited by law or by the rules of the service.”

On July 10, customs officials at a busy crossing linking Paraguay with the Brazilian city of Foz do Iguaçu confiscated nearly 6,000 weight-loss pens and vials hidden inside a vehicle. It was the largest seizure of its kind ever recorded at the Friendship Bridge, according to authorities, offering a glimpse of the scale of the trade.

Among the drugs seized was Tirzec. Representatives for Quimfa didn’t respond to requests for comment.

Once across the border, sellers advertise through social media or Meta Platforms Inc.’s WhatsApp groups or Facebook group chats, allowing customers to place an order with a simple online message.

In a statement, Meta said it doesn’t allow ads that promote the sale of illicit drugs and removes this type of content whenever it identifies violations.

The market leaves buyers with little assurance about what is inside the vials or how the products were manufactured. There are no guarantees about whether they were transported and stored at the temperatures required for injectable medicines, an especially big risk in Brazil’s hot climate.

“There’s no way to know whether a smuggled product, beyond looking like the original drug, actually contains what it’s supposed to,” said Gonzalo Vecina, a public health physician who is a professor at the University of Sao Paulo’s college of public health and was Anvisa’s first president.

Gabriela, for instance, noticed that when she occasionally buys what she says is the same Paraguayan brand of drug from a cousin instead of her usual reseller, her nausea and other side effects are worse.

Dinavisa, Paraguay’s health regulator, said that all products registered with it hold the highest quality standards and that any entering Brazil should be handled by that country’s regulator, Anvisa.

“Dinavisa conducts constant monitoring and inspections throughout the border region to prevent sales at unauthorized establishments,” said Hernan Streber, chairman of the pharmaceutical trade group in Paraguay. “Members of the association do not sell to businesses unless they have been authorized by Dinavisa.”

Alongside Brazil’s Federal Police, Anvisa has been working to address the health risks of weight-loss pens sold outside of licensed pharmacies. Seized drugs will be analyzed to determine the contents of products circulating in the market, to help strengthen criminal investigations and determine the risk to public health, according to astatement from Anvisa. The agency has also shut down illicit sales from popular websites.

The Federal Police recently launched an operation in the state of Sao Paulo, which they said uncovered evidence of a network involved in selling and distributing weight-loss drugs from Paraguay through websites and messaging apps.

Suppliers that mix compounded medications vary widely in their reliability. Anvisa said 11 inspections of compounding pharmacies and importers in 2026 resulted in 8 closures because of lack of quality control, sterilization and unidentified ingredients.

Oliveira has dealt with her share of what she assumes are side effects from the medication: nausea, an almost complete loss of appetite, difficulty eating, weakness and fatigue, as well as a decline in her performance at the gym.

The underground market in Brazil means many consumers are taking the products without medical supervision, increasing the risk of incorrect dosage or dangerous combinations with other medications.

Violent Crime

Consumers are so desperate to get their hands on more affordable versions of the treatments that they are willing to buy online with no questions asked.

That demand combined with the high value of injectable weight-loss drugs has spurred a wave of robberies in a country where more than 6 million people live on less than $3 a day.

A year ago, four suspects wearing masks and motorcycle helmets entered a pharmacy in Sao Paulo’s affluent Morumbi neighborhood. They went to the back of the store and swiped Mounjaro and Ozempic pens from the refrigerator. They killed a 57-year-old taxi driver. Three people were arrested and remain in custody, according to the police.

“With the popularization of this type of high-cost medication, we noticed an increase in pharmacy robberies, mainly targeting these medicines that are kept in the pharmacies’ safes,” said Fernando Cesar de Souza, a police chief at Sao Paulo’s 37th Precinct.

The pens stolen from the Morumbi pharmacy were taken to Paraisopolis, one of Sao Paulo’s largest slums, where such goods are then resold online, de Souza said. A pen that costs around 1,000 reais at a pharmacy could fetch roughly half that amount on the black market, he said.

About 560 pharmacy robberies were reported across the state of Sao Paulo in the first eight months of the year, down 18.5% from the same period a year earlier, according to data from the state.

In some cases, thieves make off with enough stock to match a year’s salary for multiple workers.

“At a time when these drugs are both expensive and in high demand, the incentive for criminal activity naturally increases,” said Vecina, the public health physician.

These days, customers who walk into a drugstore in Itaim Bibi, the financial district of Sao Paulo, will often see armed security guards at the entrance. Pharmacies are reducing on-site inventory, shifting sales online and promoting direct-to-consumer deliveries. Some have secured refrigerators with locks or alarms.

Health risks

Regulators face an expanding mix of products: drugs from neighboring countries, compounded medicines, stolen branded pens and potentially counterfeit or adulterated products.

Between 2018 and 2026, nearly 3,000 adverse events related to the use of GLP-1 drugs were reported in Brazil, with almost half occurring in 2025 alone, according to Anvisa. They varied in severity and include deaths.

Still, demand is only growing.

“Everyone is taking it, both people who need it and people who don’t.”

Around 6% of Brazilians currently use GLP-1s, according to a June study by Scanntech. But almost a third of the population would be interested if prices were lower, the survey found. Including people who previously took the drugs, almost half the population has used or would consider trying them.

“This is one of the most striking figures when we analyze just how far this transformation could go,” said Priscila Ariani, marketing director at Scanntech.

Rise of Generics

In Brazil, generic competition could reduce prices by up to 70%, according to estimates from Morgan Stanley. Unlike compounded products, generics are regulated, mass-produced medications.

The patent for semaglutide, the key ingredient in Novo Nordisk A/S’s Ozempic and Wegovy, expired in Brazil earlier this year, and regulators have approved several generic versions of the Ozempic shot that are just hitting the market.

Novo said it’s focused on expanding production capacity in Brazil. “We emphasize that medicines should only be purchased through authorized channels, used in accordance with approved indications and always under the supervision of a health-care professional,” the company said in a statement.

Lilly has another decade in Brazil of its patent for Mounjaro, which is marketed for weight loss in the US under the brand name Zepbound. The company offers a tool on its website that can verify whether a serial number is consistent with Mounjaro manufactured by Lilly.

In a statement, Lilly warned that other products claiming to contain tirzepatide haven’t been evaluated to approved by Anvisa. “Their sale in Brazil is illegal, and their use could seriously harm patients’ health,” the company said. “Counterfeit and illegally mass compounded versions of tirzepatide pose significant and potentially life‑threatening risks.”

Oliveira doesn’t plan to stop sourcing tirzepatide from Paraguay because there’s no generic replacement yet in Brazil.

She lost 9 kilograms (20 pounds) in three months and went from a size 38 to a size 34, roughly the equivalent of going from a 4 to a 0 in US sizes.

“I lost a ton of weight,” she said. “But it’s something that really makes you question things, because everyone is taking it, both people who need it and people who don’t.”