Introduction

This Interim Commissioning Guidance provides a framework for Commissioners to implement the National Institute for Health and Care Excellence (NICE) Technology Appraisal (NICE TA1026) and NICE Funding Variation for tirzepatide (Mounjaro®) for the management of weight during its first 3 years of delivery within the NHS in England.

The document details eligible patient cohorts, prioritisation strategy, and phased implementation of tirzepatide (Mounjaro®) across specialist weight management services and primary care settings.

Additionally, it outlines the funding allocations to integrated care boards (ICBs) to ensure effective delivery and equitable access to treatment across NHS systems in line with the NICE funding variation implementation approach.

National context

Obesity is a growing public health concern in England, with 29% of adults living with obesity (BMI ≥30 kg/m²), and 64% living with overweight or obesity.

The prevalence of obesity continues to rise, driven by a plethora of factors such as diet, sedentary lifestyles, socioeconomic inequalities, and genetic predispositions.

Obesity significantly increases the risk of developing several chronic conditions, including type 2 diabetes, cardiovascular disease, certain cancers, and musculoskeletal disorders, as well as being associated with reduced quality of life and increased mortality rates.

The rising prevalence of obesity imposes a significant economic burden on the NHS and the wider economy, costing the NHS approximately £11.4 billion annually, with this figure projected to increase with rising obesity rates and related comorbidities.

Further, the wider societal impact of obesity-related ill health costs such as lost productivity, unemployment, and social care amounts to an estimated £74.3 billion per year.

Obesity is associated with reduced workforce participation and social morbidity, lower earnings, and barriers to career progression, compounding socioeconomic inequalities.

The increasing strain on NHS primary care, specialist services, and hospital admissions underscores the need for more for cost-effective, scalable and innovative treatments and management approaches. These interventions aim to improve health outcomes, reduce long-term costs to both the NHS and society, ultimately striving to improve both individual well-being and economic sustainability.

Despite public health initiatives and lifestyle interventions to address the rising prevalence of obesity and associated comorbidities, progress has been slow.

For many adults, obesity is a chronic, relapsing condition, and while dietary changes, physical activity, and behavioural therapy play a role, achieving and maintaining substantial long-term weight loss can be a significant challenge.

However, any period of weight reduction brings meaningful health benefits, including improved metabolic health, reduced cardiovascular risk, and enhanced quality of life.

This underscores the importance of adjunctive therapies that complement lifestyle changes, offering individuals greater support to achieve sustained weight loss and long-term health improvements.

Pharmacotherapy for weight management

Pharmacotherapy represents a transformative addition to the obesity management landscape.

New pharmacotherapies for weight management offer a promising option for individuals who have not achieved clinically significant weight loss or sustained weight management with lifestyle and behavioural interventions alone.

While the efficacy of Glucagon-like peptide-1 (GLP-1) receptor agonists and the novel Gastric inhibitory polypeptide/Glucagon-like peptide-1 (GIP/GLP-1) receptor agonist, tirzepatide (Mounjaro®), for weight management are well documented in clinical trials and forms the basis for current NICE recommendations, there are important considerations which need to be taken into account in real world implementation in the NHS in England.

Due to tirzepatide’s (Mounjaro®) status as a Black Triangle medication, it is crucial to explore its practical application beyond controlled trial settings, ensuring that outcomes align with real-world patient experiences.

A key consideration is access and delivery within primary care as a new setting of care provision.

Given the novel nature of weight management pharmacotherapies in this context, implementation must be carefully aligned with system capacity, workforce readiness, and resource availability to ensure equitable and sustainable access for eligible patients.

Further, given the impact on NHS resources, eligibility will need to be phased in across the entire eligible patient population. This means that a protocol for prioritising who gets initial access to treatment is needed.

Driving sustainable and cost-effective weight management in the NHS

By implementing tirzepatide (Mounjaro®), the NHS in England will make a significant step toward transforming weight management.

Successful implementation will require robust clinical pathways, comprehensive patient and healthcare professional education, and ongoing monitoring to maximise benefits and address potential risks.

The NHS in England intends to embed weight management pharmacotherapy as one element of a broader, holistic strategy to address obesity through complementary expansion in access to lifestyle and behavioural support alongside other interventions, such as very low-calorie diets and bariatric surgery.

This will ensure that resources are used effectively, empowering individuals to achieve meaningful, lasting health improvements while maintaining cost-effective, equitable access to care across the system.

Overview of the requirements of the NICE TA for tirzepatide (Mounjaro®)

Patient eligibility criteria

Patient eligibility criteria are set out below, as per the NICE TA1026 and the NICE Funding Variation.

• “Overview of the NICE Technology Appraisal for tirzepatide (Mounjaro®)” outlines the recommended cohort eligible for tirzepatide (Mounjaro®) that is clinically and cost-effective for the management of obesity, as per the NICE TA1026
• “Overview of the NICE Funding Variation for tirzepatide (Mounjaro®)” outlines the priority cohort as per the NICE Funding Variation, for primary care settings, that are eligible under the phased access within the NHS.

Overview of the NICE technology appraisal for tirzepatide (Mounjaro®)

Tirzepatide (Mounjaro®) is a novel dual GIP/GLP-1 receptor agonist recommended by NICE technology appraisal TA1026 for managing obesity alongside a reduced-calorie diet and increased physical activity in adults, only if they have both:

• an initial body mass index (BMI) of at least 35 kg/m²*
• at least 1 weight-related comorbidity

[*Use a lower BMI threshold (usually reduced by 2.5 kg/m²) for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds.]

Tirzepatide (Mounjaro®) is recommended by NICE for use in primary care settings and specialist weight management services.

Overview of the NICE Funding Variation for Tirzepatide (Mounjaro®)

According to the eligible cohort outlined by NICE, ICBs would be required to meet the cost for funding access to tirzepatide (Mounjaro®) for an estimated 3.4 million people from 24 March 2025 (90 days from publication of the NICE TA1026).

Accordingly, NHS England submitted a funding variation request, on behalf of NHS providers and ICBs, to extend the time needed to comply with the recommendations.

NICE’s Guidance Executive accepted that NHS England’s funding variation request was justified and made the following amendments, as outlined in Section 4 “Implementation” of NICE TA1026.

Eligible patient cohort phasing and related setting of care

The NICE funding variation outlines a 90 day funding mandate in specialist weight management services for the full eligible population and a 180 day funding mandate in primary care settings in line with the prioritised patient cohorts set out by NHS England.

Implementation in NHS specialist weight management service

From 24 March 2025 (90 days after NICE final guidance publication), ICBs are required to meet the costs of funding access to tirzepatide (Mounjaro®) for the management of obesity in NHS specialist weight management services for any person who meets the eligibility criteria in the NICE TA1026 and where the treatment is approved by a prescribing clinician.

Implementation in NHS primary care settings

ICBs are required to meet the costs of funding access to tirzepatide (Mounjaro®) for the treatment of obesity in primary care settings from 23 June 2025 (180 days after final guidance publication), alongside other available treatment options, to patient cohorts on a phased basis.

Tirzepatide (Mounjaro®) will be made available to prioritised cohorts in primary care settings during an initial phased implementation period, which reflects the available capacity in primary care.

The initial implementation period will be used to evaluate and make the necessary arrangements to safely and efficiently scale a variety of implementation service models in primary care.

NICE funding variation eligible population 

The NICE funding variation has recommended the identification of an eligible cohort of 220,000 individuals over the first 3 years as part of a phased introduction for delivering tirzepatide (Mounjaro®).

The total eligible population, as outlined in the NICE TA (“Recommendations”), should have access to tirzepatide (Mounjaro®) within the maximum period of 12 years, based on cohort prioritisation led by clinical need.

This section outlines the cohorting approach for the initial 3 years of implementation, from 2025–2028. Under the cohorting approach, patient eligibility will increase in stages to approximately 220,000 patients after the first 3 years.

NICE asked NHS England to work with relevant clinical experts to consider both referral prioritisation in NHS specialist weight management services and which patient cohorts should receive access in NHS primary care-based services.

In collaboration with representatives from partner organisations, NHS England has developed an approach, referred to as the “cohorting approach” to identify the initial cohorts for access in primary care-based services.

NHS England further engaged with ICBs, patient and public voices, healthcare professionals, charities and relevant organisations, and Royal Colleges in line with its responsibilities under Section 13Q of the National Health Service Act related to public involvement.

Implementation in NHS specialist weight management services

Patient eligibility for tirzepatide (Mounjaro®) in specialist weight management services is as per the full eligible cohort as outlined in the NICE TA1026, where treatment is considered appropriate by a prescribing clinician.

ICBs have the option to align access to specialist weight management services with the proposed cohorting approach that will apply in primary care (see “Implementation in primary care settings”) in order to ensure appropriate prioritisation of resources in line with population need.

Implementation in primary care settings

Patient eligibility and the associated funding mandate within primary care is in line with the prioritised patient cohorts set out by NHS England.

The approach to implementation within primary care as a novel care setting for tirzepatide (Mounjaro®) in the management of obesity, focuses on managing primary care capacity and enabling access for patients with the highest clinical need.

Accordingly, the approach considers comorbidities as the main qualifier in clinical prioritisation, in association with BMI to phase access.

The phasing proposal for the initial 3 years of tirzepatide (Mounjaro®) implementation is outlined in Table 1.

Cohorting and phasing for access to tirzepatide (Mounjaro®) in primary care settings widens sequentially from cohort I through to cohort III:

• Funding variation year 1: Cohort I only 
• Funding variation year 2: Cohort I and II 
• Funding variation year 3: Cohort I, II and III

NICE has published timelines for implementation of the NICE Funding Variation in the NICE TA1026 technology appraisal guidance. [2026]

Table 1: Cohort access groups for implementation in primary care settings [2026]

* Funding Variation year refers to the financial year.

** Use a lower BMI threshold (usually reduced by 2.5 kg/m²) for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds.

Qualifying comorbidities definitions

The clinical definitions for comorbidities were initially based on randomised clinical trial cohort definitions, ensuring alignment with evidence-based research (Table 2).

NHS England has further refined these in collaboration with clinical experts and by reference to clinical guidelines and real-world practice, incorporating existing NICE standards and relevant Quality and outcomes framework (QOF) indicators to ensure consistency and applicability in routine care.

Table 2: Qualifying comorbidities and definitions for initial assessment

*People with type 2 diabetes can be prescribed tirzepatide (Mounjaro®) for obesity or for glycaemic management in type 2 diabetes if they meet the criteria set out in the recommendations in either:

• NICE’s technology appraisal guidance on tirzepatide (Mounjaro®) for managing overweight and obesity [NICE TA1026]
• Tirzepatide (Mounjaro®) for treating type 2 diabetes [NICE TA924]

Tirzepatide (Mounjaro®) for treating type 2 diabetes [NICE TA924] is subject to different eligibility criteria. There are clinical complexities for this cohort of patients including medication interactions and NICE recommendations should be reviewed when providing local guidelines.

Quality and outcomes framework

The QOF 2026/27 update to the GMC contract will introduce 2 obesity indicators. These aim to support practices to consistently identify adults living with obesity and enable equitable access to weight management support, including behavioural interventions and treatment options, where appropriate, following shared decision-making with the patient. [2026]

Indicator OB004 aims to ensure consistent identification of adults living with obesity and subsequent timely referral to weight management services. By standardising eligibility and referral criteria, indicator OB004 aims to reduce variation in access, with explicit attention to ethnicity-adjusted BMI thresholds to promote equitable access to behavioural interventions and treatment options, where appropriate. [2026]

Indicator OB005 supports the consideration of weight-management pharmacotherapies as per the NICE Guidance on obesity management (NG246), NICE technology appraisal (TA1026) and the associated NICE funding variation for tirzepatide (Mounjaro®) in primary care. The indicator aims to ensure equitable access for patients eligible for pharmacotherapy, as per the prioritisation approach to phased access. [2026]

Indicators OB004 and OB005 align with the NICE quality standard for the prevention, behavioural management, assessment, and treatment of overweight, obesity and central adiposity in adults (QS121). [2026]

Review QOF guidance for 2026/27 for indicator points and thresholds. [2026]

Financial allocations for implementation

Funding has been allocated in 2025/26 for the implementation of the NICE funding variation for weight loss drugs for the management of obesity for the agreed (prioritised) patient cohort.

All ICBs will receive a funding allocation for 2025/26 to cover the estimated additional cost, calculated to take account of 2 different components:

• Drug costs: the cost of weight loss drugs in both primary and secondary care for the identified priority cohorts.
• Primary care patient management costs: funding to support service delivery within primary care, as a new setting of care.

Primary care management costs are incorporated within QOF 2026/27 to support equitable, uniformity of access to pharmacotherapy in primary care across England. [2026]

The allocation is calculated on the basis of ICB level obesity prevalence. This ensures that resources are directed towards populations with higher obesity rates, addressing health inequalities and enabling ICBs to scale services effectively.

The allocation is fixed and will not be adjusted to take account of actual take-up in-year. It will not be ring-fenced.

ICBs may consider the implementation of a pre-approval process for prescribing tirzepatide (Mounjaro®) and semaglutide (Wegovy®) for management of obesity in specialist weight management services, using the NHS BlueTeq system to capture key information and may provide a clear and established framework to support ICBs to manage medicine reimbursement exclusively within specialist weight management services.

Separate funding will be retained centrally by NHS England to deliver the behavioural wraparound care required for tirzepatide (Mounjaro®) in primary care (Behavioural support for obesity prescribing) to deliver the requirement efficiently and quickly across all ICBs. [2026]

Models of care for primary care access

NICE TA1026 recommends primary care as a new care setting and point of access for tirzepatide (Mounjaro®).

To implement the NICE funding variation in primary care, NHS England have collaborated with ICBs to conceptualise 4 implementation models for the safe and effective delivery of tirzepatide (Mounjaro®) for weight management in primary care, as follows:

• Community/local-based delivery model
• General practice delivery model
• Specialist weight management services provision of community outreach delivery model
• Specialist weight management services community and general practice shared-care model

These models are indicative and intended to inform local planning. ICBs have flexibility to select the model(s) that best meets their population’s needs, with the aim of growing and scaling these models over an initial 3-year period in the primary care setting.

A defined approach to access pharmacotherapy for the management of obesity is required in all ICBs, ensuring patients meet the necessary clinical criteria before considering pharmacological treatment in consultation with the patient, accessed via the most appropriate care setting.

Local delivery models for access to tirzepatide (Mounjaro®) and other licensed weight loss drugs, need to complement integration strategies and emerging weight management pathways to ensure seamless, equitable, and effective patient care while addressing the multifaceted nature of obesity management.

The removal of tiered systems in the 2025 NICE “Overweight and obesity management” guideline (NG246) signals a shift towards reconsidering access routes and care models for obesity management beyond the stepwise tiered system.

Compliance with Online Prescribing Guidelines

Where ICBs use an online prescribing pathway for system delivery in either primary care or specialist weight management services for tirzepatide (Mounjaro®) and alternative NICE-recommended weight management medicines (NG246), Commissioners must ensure compliance with the General Pharmaceutical Council (GPhC) guidance on safe prescribing practices by all contracted service providers.

The updated GPhC guidelines stress that for high-risk medicines, such as tirzepatide (Mounjaro®), prescribing decisions cannot be based solely on the information provided in an online questionnaire.

Prescribers are required to independently verify the information given by the patient through timely 2-way communication, accessing the patient’s clinical records, or contacting the patient’s GP or another regular prescriber.

This approach is considered essential to prevent the potential misuse of the system and ensure that patients are prescribed medicines that are clinically appropriate for their individual health needs.

Wrap-around care provision and access

The NICE TA1026 and the associated Medicines and Healthcare products Regulatory Agency (MHRA) product license approval emphasise wrap-around care as an essential adjunct for tirzepatide (Mounjaro®), for the management of obesity, which must be prescribed alongside a reduced-calorie diet and increased physical activity.

The NICE TA1026 effectively mandates provision of wrap-around care alongside the prescribing of tirzepatide (Mounjaro®) for all patients receiving tirzepatide (Mounjaro®), regardless of their setting of care.

• For the delivery of the NICE funding variation in the NHS in England, all patients must be provided wrap-around support that incorporates nutritional and dietetic advice as a minimum, and access to behavioural change components, as a mandatory requirement to access treatment.
• Provision of wrap-around care will align with NICE quality standard QS212 “Quality statement 6: Wrap-around care alongside medicines for weight management”. [2026]
• Provision in specialist weight management services: where patients are prescribed tirzepatide (Mounjaro®) in a specialist weight management services, through a multidisciplinary team that offers a combination of nutritional, psychological and medical intervention, based on the individual patient’s needs, further provision of wrap-around care is not necessary.
• Provision in primary care: Where patients are prescribed tirzepatide (Mounjaro®) in primary care additional wrap-around care will need to be provided. The NICE TA1026 does not specify the exact content of wrap around care in this setting related to tirzepatide (Mounjaro®). Through a review of NICE published guidelines and quality standards for related services, the lifestyle intervention provision in related SURMOUNT clinical trials,* and in consultation with relevant professional and patient groups, an informed approach to the development of an effective wraparound care service, to be delivered for primary care, has been taken by NHS England.

[*Jastreboff, AM, Tirzepatide Once Weekly for the Treatment of Obesity, New England Journal of Medicine, 2022;
Frandsen, CS, SURMOUNT-2: new advances for treating obese type 2 diabetes with tirzepatide, The Lancet;
Wadden TA, et al Tirzepatide after intensive lifestyle intervention in adults with overweight or obesity: the SURMOUNT-3 phase 3 trial, Nat Med. 2023;
Aronne LJ, et al; SURMOUNT-4 Investigators. Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial, JAMA. 2024.]

Given the expected patient numbers to be treated over the early phase of implementation, a dedicated wrap-around care service exclusively for tirzepatide (Mounjaro®) is unlikely to be viable in the short term.

To support consistent access to a support offer across all ICBs, NHS England intends to use existing service infrastructure, specifically, leveraging appropriate established provider networks to provide a short-term option.

This approach will allow for rapid mobilisation of services through existing contracts, ensuring efficient and equitable care delivery.

NHS England intends to make centrally funded wrap around care services available to all ICB from 23 June 2025, which will be accessible from primary care settings. This will be exclusively for use by the identified priority cohort, for each ICB. The access and associated service pathway will be confirmed with all ICBs in May 2025.

Where patients’ care is initiated and managed within primary care settings, ICBs can opt to use the NHS England provision of wrap around care or may choose to independently provide wrap around care.

In the latter instance, commissioners are required to ensure wrap around care is made available to this cohort of patients which incorporates appropriate nutritional and dietetic advice, physical activity guidance and behavioural change components, over a minimum time frame of 9 months from the point of prescribing initiation.

Further information on wraparound care in primary care settings can be found at NHS England “Tirzepatide (Mounjaro®) in primary care for weight management: information on wrap-around care”. [2026]

Patient management

ICB patient management protocols, clinical guidance and clinical governance policies should be delivered in line with the NICE TA1026 and the NICE “Practical guide to using medicines to manage overweight and obesity”.

For the management of patients in primary care, monthly face-to-face appointments with a suitably trained healthcare professional should be conducted during the titration phase of tirzepatide (Mounjaro®), with structured medication reviews incorporated in the management pathway for at least the first 12 months of prescribing.

All patient reviews should take a holistic approach, monitoring physical outcomes such as weight loss and associated recording of BMI, comorbidity indicators, consideration of deprescribing, as well as potential adverse effects, including psychological impacts. In line with NICE guideline NG246, the correct and suitable equipment and facilities for managing people living with overweight should be made available in all settings of care.

Initiating prescribing and titration guidance

Local commissioners should ensure that prescribing of tirzepatide (Mounjaro®) aligns with the eligibility criteria outlined by the NICE TA1026, as well as the licensed indication and dosage schedule available in the NICE prescribing information for tirzepatide (Mounjaro®), the summary of product characteristics and the British National Formulary (BNF).

NICE has developed tirzepatide: local formulary information to support the adoption of tirzepatide (Mounjaro®) into local formularies.

The prescribing of tirzepatide (Mounjaro®) should be conducted in accordance with robust local system clinical governance, with clinical and expert advice guiding the process.

Commissioners should ensure that the initial assessment for tirzepatide (Mounjaro®) prescribing in primary care is performed by an appropriately trained healthcare professional and it is recommended this assessment should include as a minimum:

• eligibility assessment, to include:
  • BMI assessment and comorbidity complexity according to NICE TA1026 and NICE funding variation for tirzepatide (Mounjaro®)
  • medical history, including comorbidities and concomitant medication
  • suitability for treatment, including contraindications and cautions, psychological assessment
  • relevant assessments depending on clinical circumstances
• Review of concomitant medicines and polypharmacy (consider NICE “Practical guide to using medicines to manage overweight and obesity”).

Further information on the initial assessment can be found in the NICE “Practical guide to prescribing medicines to manage overweight and obesity”, and the NICE ”Initial assessment checklist” for a list of actions or assessments that may be needed.

MHRA has produced guidance on GLP-1s medicines, including side effects, pregnancy and contraception, mental health, pre-surgical prescribing, and safe access. [2026]

Further information on pregnancy and contraception can be found at the College of Sexual and Reproductive Healthcare “FSRH statement: Glucagon-like peptide-1 (GLP-1) agonists and oral contraception” and patient information leaflet. [2026]

To support discussions between healthcare professionals and people considering the use of tirzepatide (Mounjaro®), consider NICE “Discussion aid for healthcare professionals and patients”. [2026]

The appropriately trained healthcare professional undertaking the initial assessment should discuss the factors related to the choice of medicines, or alternative treatments and services available to the patient, when making a decision on treatment appropriateness, as outlined in the NICE “Practical guide to prescribing medicines to manage overweight and obesity”.

The Edmonton Obesity Staging System (EOSS) may be used to provide an individual subjective assessment of the severity of obesity-related health, to include a holistic assessment of the presence and severity of obesity-related comorbidities, mobility and functioning, and psychological symptoms and wellbeing.

In line with the GPhC guidance on prescribing weight loss medications, prescribers should carefully consider the patient’s overall wellbeing, particularly when eating disorders, body dysmorphia, or mental health status are factors in the request and consideration for treatment.

Onward referral to dedicated services may be made where appropriate, in line with local guidelines and existing NICE Guidance (NG222).

Due to the current Black Triangle status of tirzepatide (Mounjaro®), commissioners and prescribers are required to exercise extra caution and adhere to rigorous protocols to ensure the drug is appropriate and safe for each patient, prioritising comprehensive clinical evaluation and ongoing monitoring throughout the course of treatment.

ICBs may wish to consider the implementation of a prior approval system for the prescribing of semaglutide (Wegovy®) and tirzepatide (Mounjaro®) in specialist weight management services to support with cost management and resource planning.

For example, BlueTeq. Implementation of a prior approval system would also allow data collection, ensuring that specialist weight management service providers prescribe in line with locally defined referral criteria.

Patient monitoring

Further information on the follow up and monitoring required for tirzepatide (Mounjaro®) can be found in the NICE “Practical guide to using medicines to manage overweight and obesity”. Also consider the NICE “Follow up and monitoring checklist”, detailing actions or assessments that may be needed during dose titration and once on a stable dose.

Reviewing and stopping prescribing

Unlike other NICE-recommended weight management medicines, which currently have a maximum prescription duration of 2 years, tirzepatide (Mounjaro®) for the management of obesity, does not have a set “stopping rule” or maximum treatment period, allowing for indefinite prescribing.

The decision to continue short or long-term prescribing should be made on a case-by-case basis by an appropriately trained healthcare professional, in consultation with the patient.

This decision must consider the clinical benefits and risks of treatment. If at least 5% of initial body weight has not been lost after 6 months, at the highest tolerated dose, healthcare professionals should reassess the appropriateness of continuing treatment and consider alternative therapies if clinical benefits, including weight loss, are not observed.

It is the responsibility of ICB commissioners, clinical leads and prescribers to stay informed and up to date with the latest guidelines and prescribing recommendations for weight management treatments, including tirzepatide (Mounjaro®), as per NICE Quality Standard QS212. [2026]

Commissioners should ensure that local clinical governance frameworks are aligned with updated guidelines and that the delivery of services reflects the most current standards of care. This includes regularly reviewing and adapting policies and procedures to ensure safe, effective prescribing and optimal patient outcomes, while also fostering a culture of continuous improvement and evidence-based practice within the healthcare system.

If deprescribing occurs, advice for maintaining changes and support for improving their health and wellbeing may be provided, as per NICE Quality Standard QS212 “Quality statement 7: Advice and support after stopping medicines for weight management or completing behavioural interventions”. [2026]

Incidence and adverse event reporting

Tirzepatide (Mounjaro®) is classified as a Black Triangle medication by MHRA, meaning it is subject to additional safety monitoring.

Healthcare professionals, the public, and pharmaceutical companies must report all suspected adverse drug reactions via the Yellow Card Scheme, accessible through the website, app, telephone, or clinical IT systems, as well as standard patient safety reporting mechanisms.

SNOMED CT codes are available to record and report adverse events related to all weight loss medications. Known tirzepatide (Mounjaro®) side effects and cautions are detailed in the BNF.

Table 3: SNOMED CT code guide for adverse reactions: Located under the Parent ID of 62014003 Adverse reaction caused by drug (disorder)

*Due to the terminology currently used in the SNOMED CT browser, tirzepatide has the parent code ‘Glucose dependent insulinotropic peptide (substance) SCTID: 416401008’.

Local population needs

Local systems should continue to consider weight management services for specific populations disproportionately affected by excess weight and groups who experience significant barriers to equitable access of services.

Commissioners should review their current models of care and develop multidisciplinary team approaches to support vulnerable people to be able to access treatment and care.

Ethnicity

There is an increased risk of health conditions at lower BMI thresholds in certain populations.

Therefore, BMI applied to assess eligibility for tirzepatide (Mounjaro®) must be adjusted by 2.5 kg/m² in people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds to ensure equitable clinical prioritisation and access to appropriate treatment.

Severe Mental Health, Learning Disabilities and Autism

People with severe mental health conditions, a learning disability or who are autistic, are at higher risk of cardiometabolic disease and will potentially benefit from weight management support and treatment with weight loss therapies, including tirzepatide (Mounjaro®).

These patients should be actively supported to access treatment unless there is a clinical reason not to do so.

However, because people with severe mental health conditions, a learning disability, or who are autistic, are not well represented in clinical trials, caution and heightened vigilance is advised.

The BNF entry advises: “Tirzepatide delays gastric emptying, particularly following the first dose. This has the potential to slow the rate of absorption of concomitant oral medicines. The risk of a delayed effect should be considered for oral medicines where a rapid onset of action is important. Monitor patients on oral medicines with a narrow therapeutic index, especially at the start of tirzepatide (Mounjaro®) treatment and after dose increases.”

Appropriate advice on hydration should be offered alongside the importance of exercise.

For people living with severe mental health conditions, a learning disability, or who are autistic, clinicians should be particularly aware of gastrointestinal side effects and the need to avoid constipation, which might be anticipated to be more severe and are commonly experienced with some patients who are co-prescribed antipsychotics.

It is important to include carers in the conversation, explaining side effects to look out for, and providing advice on the disposal of sharps.

The BNF advises further on important safety information and additional monitoring needs related to potential drug-drug interactions which may increase blood levels of antipsychotic therapies and consideration of potential impairment of intestinal peristalsis antipsychotic therapies.

Children and young people

The development or continuation of clear transition pathways for prescribing and monitoring of all weight management pharmacotherapies for young people moving into adult services from complications from excess weight (CEW) clinics and paediatric services is recommended.

Detained persons

Primary care services commissioned by the NHS within residential custodial settings should ensure appropriate delivery and support of equitable access to tirzepatide (Mounjaro®) for the management of obesity, through established local care pathways, in line with access provided by community general practice. [2026]

Access to wraparound care is an essential component of safe and effective prescribing and must be enabled within custodial settings through local arrangements. [2026]

Local arrangements aligned with the ‘NHS Health and Justice Framework for Integration 2022–2025: Improving lives – reducing inequality’ are recommended to embed consistent, equitable pathways through a whole systems approach to care.

Housebound

ICBs and local authorities should ensure appropriate delivery and support of equitable access to tirzepatide (Mounarjo®) for patients who are housebound.*

Equitable access may include considering the use of a community-based multidisciplinary team approach, to include social prescribing, community dietetics, and other appropriate services, where available, as well as the systems’ neighbourhood health and care model for the local population.

[*A patient is deemed to be housebound when they are unable to leave their home or require significant assistance to leave their home environment due to illness, frailty, surgery, or mental health.]

Implementation activity in primary care settings

General practice IT template

A general practice IT (GPIT) template was published in June 2025 to provide a structured approach for capturing essential data within current GPIT systems (including EMIS and TPP SystemOne).

This standardised Integrated Patient Review Template has been rolled out on a national scale in England for all GP practices through NHS England’s GPIT Providers.

The template ensures consistent capture of both clinical and administrative data across healthcare providers, improving data quality and reliability. It includes fields for key metrics such as patient demographics, treatment eligibility, contraindications, medication history, side effects, and treatment outcomes.

The template’s standardised data fields enhance data accuracy by minimising variability in entries, leading to more reliable patient records.

With clear, consistent fields guiding clinicians through each entry, the completeness of these records will improve, providing a comprehensive view of each patient’s needs and treatment progress.

The template also includes step-by-step guidance on assessment criteria, contraindications, and follow up requirements, ensuring alignment with evidence-based guidelines and appropriate patient care throughout their treatment journey.

This is not a clinical management template. The GPIT template has been introduced to confirm assessment of the patient under the NHS priority cohorts under the NICE funding variation for tirzepatide (Mounjaro®) for the management of obesity in primary care.

It is the prescriber’s responsibility to review the BNF cautions, medication interactions, summary of product characteristics (SmPCs), and local criteria.

Review template access to access templates that support obesity prescribing pathways across GPIT systems. [2026]

SNOMED CT codes

To support tracking of the NHS obesity medicine pathway, SNOMED CT codes are published within the SNOMED CT browser in the March 2025 release for use across all care settings (Table 4).

These are held under the parent code “NHS obesity medication pathway”. 2 regime/therapy codes subsequently distinguish between the tracking and monitoring of prescribing and monitoring, and wrap-around care: “NHS obesity medication pathway (regime/therapy)”, and “NHS obesity medication wraparound support pathway (regime/therapy)”.

These codes are integrated into general practice IT systems and also available for use in secondary care settings.

Enabling consistent coding of activity related to the delivery of the NICE funding variation for tirzepatide (Mounjaro®) across key steps in the patient journey – including initial assessment, referral to wrap-around care, prescription monitoring, and treatment completion – provides a standardised approach for tracking patient management and reporting activity.

Table 4: SNOMED CT Code guide for the NHS obesity medication pathway in primary care settings: Located under the Parent ID of NHS Obesity Medication Pathway [2025, amended 2026]

The SNOMED CT codes for NHS obesity medication pathway flowchart outlines how the relevant SNOMED codes correspond with the obesity medication pathway in primary care settings. [2026]

System reporting of implementation and access

Aggregated data will be requested by NHS England from ICBs in a standardised format, at 4 points for year 1 of implementation, to inform on the prescribing of tirzepatide (Mounjaro®) in primary care settings and the management of patients.

ICB submissions to the Data Collections Framework Platform will be extended to enable continued national data capture.

Therefore, NHS England will be requesting that ICBs continue to provide data returns via the Data Collections Framework Platform until the end of 2026/27. [2026]

Data collection timeframes:

• Activity to end September 2025
• Activity to end December 2025
• Activity to end February 2025
• Complete 2025/26 activity
• Activity to end of June 2026 [2026]
• Activity to end of September 2026 [2026]
• Complete 2026/27 activity [2026]

ICB-level aggregate data will enable NHS England to observe the delivery of the NICE funding variation for tirzepatide (Mounjaro®), understand access, and identify trends and prescribing practices.

Collated information generated from this aggregated data will help shape reporting requests from the Department of Health and Social Care, and support informed decision-making on future financial allocations and implementation. [2026]

For further information regarding data collection on tirzepatide (Mounjaro®) in primary care, see background information, submission dates and data collection guidance. [2026]

Review of implementation and access

NICE will conduct a formal review of the implementation of the NICE funding variation to be completed within 3 years from the date of final guidance publication.

An independent evaluation of the implementation of tirzepatide (Mounjaro®) has also been commissioned by the National Institute for Health and Care Research (NIHR), through its Health Services Delivery Research (HSDR) Programme. 

The evaluation will generate comprehensive data across delivery models to evaluate feasibility, acceptability, safety, effectiveness, and cost-effectiveness of new models for providing weight loss drugs across socio-demographic groups.

To achieve the aims of the evaluation, the appointed research partner will engage with healthcare professionals, patients, and providers, across ICBs, to understand the impact of delivery models to accessing tirzepatide (Mounjaro®).

For further information, visit NIHR National Evaluation of Weight Medication Access. [2026]

Publication reference: PRN01879