Weight loss medication

People in England over the age of 18 living with obesity and weight-related health issues, will be able to access the weight loss drug tirzepatide (Mounjaro®). Tirzepatide (Mounjaro®) is currently prescribed for the treatment of type 2 diabetes mellitus but will now also be available for weight loss purposes.

Introducing this new treatment to an estimated 3.4 million eligible patients requires the NHS in England to develop a completely new service for weight management. Healthcare professionals will need to be trained to deliver it. A staged approach will help manage pressures on existing healthcare services. This allows the safe prescribing of tirzepatide (Mounjaro®) and the appropriate support for patients.

Tirzepatide (Mounjaro®) will initially be offered to individuals facing the most significant health risks related to their weight, starting in March 2025 through specialist weight management services. People who are prioritised for eligibility for tirzepatide (Mounjaro®) through primary care services should expect to start to get access from June 2025.

The weight loss drug tirzepatide, also known as Mounjaro®, is a GLP-1 agonist and GIP agonist. Other medications such as semaglutide (Wegovy®), liraglutide (Saxenda®), are known as GLP-1 agonists. They mimic gut hormones released by the body after eating, telling the brain you are full; they also slow down the time it takes the stomach to empty.

Until now, most of these drugs have been used in the NHS to treat diabetes, to help control blood sugar levels as well as encouraging weight loss, helping improve diabetes and other health conditions.

Tirzepatide (Mounjaro®) can only be prescribed by a healthcare professional alongside programmes that support people to lose weight and live healthier lives by making changes to their diet and physical activity. Tirzepatide (Mounjaro®) is an injection, which you inject yourself once a week.

Following June 2025, the cohorts of patients set out below will be eligible for access to tirzepatide (Mounjaro®) in the first 3 years of delivery. There will be a phased approach to service rollout within primary care and, initially, tirzepatide (Mounjaro®) will only be available on the NHS to those with the highest clinical need.

This approach will ensure the service is delivered safely and that the NHS in England is able to plan for an increase in the numbers of people eligible for assessment for tirzepatide (Mounjaro®), whilst building skills and knowledge within the workforce. The National Institute for Health and Care Excellence (NICE) will complete a review at 3 years about who else will be able to access the medication. After that, more information will be provided about the next groups of people.

Access to the medication will be prioritised to ensure patients with the greatest clinical need

can access it. This approach was developed based on discussions with clinical experts and engagement with key organisations. The following weight-related health conditions will be used to define the first eligible cohorts:

• type 2 diabetes mellitus
• high blood pressure
• heart disease
• obstructive sleep apnoea (when your breathing stops and starts while you sleep)
• abnormal blood fats (dyslipidaemia)

Cohort 1 – will start in June 2025. At least 4 of the 5 health conditions listed above plus a BMI of at least 40 (BMI to be adjusted for ethnicity*).

Cohort 2 – in addition to the patients in Cohort 1, access to the drug will also be offered to patients meeting the following criteria in year 2. At least 4 of the 5 health conditions listed above plus a BMI of 35 to 39.9 (BMI to be adjusted for ethnicity*).

Cohort 3 – in addition to patients in Cohorts 1 and 2, access to the drug will also be offered to patients meeting the following criteria in year 3. At least 3 of the 5 health conditions and a BMI of at least 40 (BMI to be adjusted for ethnicity*).

*Due to an increased risk of heath conditions at lower BMI thresholds in the following populations, the BMI used to assess eligibility for tirzepatide (Mounjaro®) will be 2.5 kg/m2 lower for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds.

Tirzepatide (Mounjaro®) might not be suitable for everyone and not everyone who meets the eligibility criteria will want to use it to support their weight loss. There are other options available including weight loss programmes that use tried and tested methods such as lifestyle and behavioural changes, nutrition and physical activity advice. Please speak to a healthcare professional about the best option for you in your local area.

Some options depend on the health-related conditions you have and your BMI. The NHS Digital Weight Management Programme is available for those with diabetes, high blood pressure (or both) and who have a BMI greater than 30. The BMI threshold is lowered to 27.5 for those from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds. NHS staff do not need high blood pressure or type 2 diabetes to access this programme.

The NHS Type 2 Diabetes Path to Remission Programme is available if you are aged 18 to 65, have a diagnosis of type 2 diabetes within the last 6 years and have a BMI over 27 kg/m2 (for people from White ethnic groups) or over 25 kg/m2 (for people from Black, Asian and other ethnic groups).

Adults can access the NHS Diabetes Prevention Programme if they have had a blood test in the last year that shows they are at risk of diabetes.

Like all medications, tirzepatide (Mounjaro®) can have side effects, and healthcare professionals should discuss these with you. The medication comes with a patient information leaflet listing common side effects including:

• feeling sick
• indigestion
• constipation
• diarrhoea

There can be some more serious side effects, such as low blood sugar, gallstones and inflammation of the pancreas (pancreatitis).

Tirzepatide (Mounjaro®) is a new medication and any side effects should be reported through the Yellow Card Scheme, the government’s system for tracking medicine-related side effects.

NICE guidance recommends that, if you do not lose enough weight (5%) after 6 months of being on the highest dose you can manage, tirzepatide (Mounjaro®) should be stopped. This is because the medication is not working as well as it should be for you.

Currently, there is no specified time limit for tirzepatide (Mounjaro®) prescriptions. The decision to continue or stop tirzepatide (Mounjaro®) should be discussed with an appropriate healthcare professional.

If you are trying to get pregnant, you should have a discussion with an appropriate healthcare professional. There are specific recommendations about when to stop the medication before trying to get pregnant. Tirzepatide (Mounjaro®) is not recommended in pregnancy or during breastfeeding because we have limited safety data. It should be stopped if you become pregnant.

The Faculty for Sexual and Reproductive Health has produced a patient information leaflet about how these medications affect contraception like the pill.

Patients can continue taking tirzepatide (Mounjaro®) if they are prescribed it by the NHS to manage their diabetes. If you have any questions, contact a suitable healthcare professional.

If patients are using tirzepatide (Mounjaro®) bought privately, they may be able to access the medication through an NHS prescription if they meet the NHS qualifying criteria outlined above.

It is important that your GP is aware you are taking tirzepatide (Mounjaro®) if it hasn’t been prescribed by the NHS. It may affect your health and interact with other treatments.

A healthcare professional will determine if it is appropriate for you to receive tirzepatide (Mounjaro®) as part of your care in a different care setting (for example, through primary care).

Every patient prescribed tirzepatide (Mounjaro®) on the NHS is required to participate in a specifically designed ‘wrap-around’ care service, as stipulated under NICE guidance. This focuses on diet, nutrition and increasing physical activity. Patients cannot be prescribed tirzepatide (Mounjaro®) if they do not wish to get the wrap-around care support.

No – if you get your medication prescribed by your GP, this will include a referral to a healthy lifestyle programme to help people to lose weight through changes to their diet, nutrition and physical activity.

NHS commissioning of tirzepatide (Mounjaro®) for the management of obesity continues to be for the NHS eligible cohort of people, i.e. those with a BMI of 40 or more in addition to four of more qualifying comorbidities. This is in line with NHS England’s interim national commissioning guidance for the implementation of NICE TA1026.

For people who have previously accessed tirzepatide through a private provider, the NHS may only continue treatment if, following an assessment by the Integrated Care Board’s commissioned weight management service, the individual meets the eligibility criteria at the time they present to the NHS.

If a person seeking treatment does not meet the eligibility criteria in the NHS, they should be advised of this. We recognise this may be disappointing for people. NHS teams, including primary care providers, could provide reassurance to the person that stopping tirzepatide that is being taken for its licensed weight loss indication, is not known to cause withdrawal symptoms, but that they should continue, where appropriate, a reduced-calorie diet and increased physical activity if they want to reduce the risk of weight regain.

Any person presenting to an NHS service with questions about their private tirzepatide prescription, including stopping or tapering off the drug, should be directed to speak with their private provider.