Mounjaro cleared for NHS use, but patients may have to wait

Eli Lilly's weight-loss jab Mounjaro has been cleared for rollout by the NHS in England, with around 3.4 million people eligible, but will be made available in stages to limit the financial impact.

It could take up to 12 years for Mounjaro (tirzepatide) to become available for everyone who fulfils the criteria set by cost-effectiveness agency NICE in its recommendation (PDF) – adults who have a body mass index (BMI) of at least 35 kg/m2 and at least one weight-related health problem.

That includes high blood pressure, elevated cholesterol, obstructive sleep apnoea, cardiovascular disease, and prediabetes or type 2 diabetes.

It's a narrower indication than has been approved by the UK medicines regulator, the MHRA, which covers use in any person with a BMI of 30 or more and 27 to 20 in people with at least one comorbidity.

The dual GIP/GLP-1 receptor agonist will initially be offered only to around 220,000 people with the highest clinical need, according to NICE, which stressed that Mounjaro must be given with a commitment to adhere to a reduced-calorie diet and increased physical activity.

NHS England will develop a plan to work out which other groups of patients will be offered the drug over the next three years and has said it intends to publish initial guidance early in 2025.

The plan reflects real concerns that the prices of the new generation of so-called 'incretin' obesity therapies could place a heavy burden on the already over-stretched NHS in the near term, even though they have benefits that extend beyond weight loss and into related chronic diseases that could eventually save money.

"The rollout of tirzepatide has to be carefully managed to ensure healthcare professionals can continue to meet the full range of health needs of all their patients," said NICE in a statement. Lilly is making Mounjaro available to the NHS at a confidential discount to the drug's list price of between £92 and £122 – depending on dose – for a four-week supply of the drug.

Lilly welcomed NICE's decision and acknowledged the need for a phased introduction, but criticised the proposed timeline.

Fernando Campo, head of diabetes and obesity at Lilly Northern Europe, said it means that "fewer than one in 10 of these eligible patients will be able to access treatment within the first three years."

He added that the company intends to work with NHS England "to ensure we can best meet the current unmet need of people living with obesity and deliver on the government's obesity goals."

NICE's decision comes shortly after Lilly reported the first head-to-head clinical data, showing that Mounjaro was more effective than its arch-rival Wegovy (semaglutide) from Novo Nordisk in achieving weight loss.

Wegovy has been backed for routine NHS commissioning in the same patient population since 2022, and in "exceptional circumstances" among patients with a BMI of 30 or over. Novo Nordisk launched it in the UK in September 2023.

Commenting on the decision, Professor Lora Heisler, chair in human nutrition at the University of Aberdeen's Rowett Institute, said: "This is a very important step forward in helping patients with health complications associated with obesity to receive the most effective medicine currently on the market to help improve health through weight loss."

She added that it could help improve health more broadly on a national scale, benefitting both the NHS and UK economy, but cautioned that "tirzepatide is not a magic cure" as it has side effects and must be taken alongside diet and exercise to be effective.

"It is particularly important for obese patients requiring drugs to help shift weight to engage in physical activity whilst taking the medicine," said Heisler. "This is because weight loss primarily leads to the loss of body fat, but also commonly leads to the loss of some muscle."