Weight Loss Medication

Medical Therapy statement: 23 December 2024

An update on weight loss medication, tirzepatide

On 23 December 2024 the National Institute for Health and Care Excellence (NICE) published the Technology Appraisal in relation to tirzepatide (Mounjaro™) which is a new drug for managing obesity.

Initially, tirzepatide will only be available in specialist weight management services whilst Integrated Care Boards (ICB) await further national guidance.  In the short term this medication will not be available from GP practices.  NICE have indicated in the guidance that it could take up to 12 years to make it fully available to the eligible population.

What is changing in the management of obesity because of NICE’s announcement?

Tirzepatide is currently prescribed for the treatment of type 2 diabetes but will shortly also be available for weight loss purposes.

People in England over the age of 18 who are living with obesity and another weight-related health issues will be able to access the weight loss drug tirzepatide through specialist weight management services from spring 2025.

Who can access tirzepatide?

Eventually this medication will be available for people living with obesity who have a body mass index (BMI) of 35 or over and a weight-related health problem; or a BMI of 32.5 and one weight related health problem; or people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds, who are at a higher risk of medical problems at a lower BMI.

NHS England will provide more information early in 2025 to set out the criteria and the patients who will be eligible for tirzepatide.

Can I access tirzepatide straight away?

Introducing this new treatment to NICE’s estimated 3.4 million eligible patients requires the NHS in England to develop a completely new service for primary care and many healthcare professionals will need to be trained to deliver it.

A staged approach will help manage demand on existing healthcare services. This allows the safe prescribing of tirzepatide and the appropriate support for patients.

tirzepatide will initially be offered to individuals facing the most significant health risks related to their weight, starting in spring 2025 through specialist weight management services.

Tirzepatide will not immediately be available and will not be accessible to everyone who wishes to use it.  Initially, tirzepatide will only be available on the NHS to those expected to benefit the most.

How does tirzepatide work for weight loss?

Tirzepatide works by supressing appetite centres in the brain that control gut hormones. It decreases the appetite and slows the movement of food passing through the body, making you feel fuller for longer.

Clinical trials have shown tirzepatide can help people living with obesity lose up 20% of their starting body weight, depending on the dose and accompanying diet and lifestyle support.

Tirzepatide can only be prescribed by a healthcare professional alongside programmes which support people to lose weight and live healthier lives by making changes to their diet and physical activity.

Tirzepatide comes as an injection, which can be self-administered once a week.

What if a patient is already receiving tirzepatide treatment?

Patients can continue taking tirzepatide if they are prescribed it to manage their diabetes.

If patients are using tirzepatide they have acquired privately, they may be able to access the medication through an NHS prescription if they meet the NICE and NHS qualifying criteria. However, patients should not gain advantage over other patients waiting for NHS care.  More information about this will be made available in the new year.

Will everyone who is eligible have access to the drug?

Tirzepatide might not be suitable for everyone and not everyone who meets the eligibility criteria will want to use it to support their weight loss. A healthcare professional will discuss the most appropriate care and support, based on individual patient’s need. This could include behavioural support programmes, medical options including prescribing or bariatric surgery.

The NICE announcement mentions ‘wraparound’ care. What does this mean?

Any patient prescribed tirzepatide must participate in the specifically designed ‘wraparound’ care required by NICE guidance. This focuses on diet, nutrition and increasing physical activity. As NHS England develops the service, it will provide more details of the wraparound support offer for patients who qualify.  Patients cannot be prescribed tirzepatide if they do not wish to undertake the wraparound care support.

Will there be a cost to the patient for being prescribed tirzepatide?

Normal prescription charges will apply unless you are entitled to free NHS prescriptions (for example, because you have a medical exemption certificate).

Medical Therapy statement: 29 July 2024

Thank you for your interest in GLP-1 medical therapy for weight loss. Over the last few years, the demand for these therapies has been unprecedented. Unfortunately what is represented in the media and through the private sector is not representative of what is currently possible within the NHS. Despite various drugs being licensed and approved by the National Institute for Health and Care Excellence (NICE) for weight loss, actual implementation within most NHS services across the country has been challenging for a number of key reasons:

1. Certain drugs have been limited to prescribing within specialist weight management services only. Only 44% of NHS Trusts provide specialist obesity services (Tier 3). This places existing services such as ours under immense pressure – increasing waiting lists and workload for an already overstretched workforce. This means we can not safely serve every patient who meets criteria. As consistent with the national position and endorsed by our Drugs and Therapeutics Committee,  roll-out will therefore be done in phases. We will initially focus on the highest risk patients for phase 1 and there are clear criteria for this phase. If you meet these criteria then we will inform you. If you do not meet these criteria, we will not routinely inform you but you will be provided with this statement should you request further information. We are unable to respond to repeated demands unless there has been a relevant change in your clinical status as this places additional demand on staff and compromises care for other patients. Repeated or aggressive demands will follow Trust behavioural policy.
2. There has been an increased global demand for GLP-1 analogues outpacing increases in manufacturing capacity, exacerbated by wide-spread cross-prescribing of GLP-1 analogues indicated for diabetes. In June 2023, a National Patient Safety Alert was published indicating that no new prescriptions should be initiated for certain drugs. This places increasing pressure on available drugs and means that we must work to manage supply for the highest risk patients
3. Anecdotally, many patients have been unable to obtain the medication and have resorted to purchasing privately, through the black market or from abroad. This has led to further confusion and mixed messaging.
4. GLP-1 prescription pathways lead to increased costs and staffing needs for the service. It is crucial that these pathways are mapped out with appropriate support for follow up and reliable prescription delivery across a wide geographical region such as ours. This is a significant process which requires extensive work and agreement. It is essential that this is done safely so we do not place any patients at risk.

Based on these factors, we will adopt a phased approach to delivery of medical therapy. This position of Bedfordshire Metabolic Institute Tier 3 is consistent with national guidance for implementation. Our key priorities are to ensure that we start provision of GLP-1 therapy but do this safely and effectively.  As with any prescription, it is vital that people are screened and receive appropriate support alongside. Whilst we work towards shared decision making, it is ultimately a prescribers decision as to whether to prescribe a drug.

We appreciate from working with people living with obesity the detrimental impact it can have on both physical and emotional health. Therefore it is understandable that limitations around accessing medical and other therapies can be frustrating. We hope the above therefore provides clarity for why a phased approach is being taken. Thank you for your understanding.

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