ICBs ration Mounjaro prescribing by GPs with additional eligibility criteria
Some ICBs are imposing their own thresholds for prescribing weight-loss drug tirzepatide (Mounjaro) through primary care that go further than the national thresholds, an investigation by Pulse’s sister title The Pharmacist has revealed.
Data obtained from freedom of information (FOI) requests sent to all 42 ICBs found that some areas exclude patients with unstable mental illness, others prioritise patients from more deprived areas, and one ICB is set to require patients to undergo supported attempts to lose weight before being prescribed the drug.
In June 2025 GPs were given the go ahead to start prescribing tirzepatide (Mounjaro) for obesity. While it has been available since 2022 as a treatment for diabetes, this new indication was described by health secretary Wes Streeting as a ‘game changer’ in the fight against obesity.
Under the national criteria, the first cohort of patients who are eligible for tirzepatide on the NHS must have a BMI over 40 and four or more weight-related comorbidities such as hypertension, sleep apnoea, dyslipidaemia or cardiovascular disease. The second cohort to be prescribed tirzepatide must have a BMI of 35 – 39.9 and four or more comorbidities; the third cohort must have a BMI over 40 and three or more comorbidities.
However, The Pharmacist investigation revealed that many ICBs were implementing their own thresholds. For example:
- Humber and North Yorkshire ICB’s primary care weight management service has a list of exclusion criteria including patients with unstable mental illness, patients with a diagnosed eating disorder, and those who have undergone bariatric surgery in the past 12 months.
- In Lancashire and South Cumbria ICB, only patients who live in one of the most deprived areas – according to the government’s indices of multiple deprivation – are eligible for tirzepatide.
- NHS South Yorkshire ICB will apply the same thresholds for treatment to cohort one but for future cohorts, ‘patients will be required to have completed, in the last 24 months, a supported attempt to lose weight prior to consideration of weight loss drugs’.
- And Greater Manchester ICB has applied ‘local prioritisation’ within cohort one by dividing it into three sub-cohorts to prioritise patients with the highest clinical needs. As well as this, there are clear differences in spend across the country, with deprived areas spending the most.
Meanwhile, NHS spending on tirzepatide has risen by up to 200% since GPs were first able to prescribe it in June 2025. The amount of money spent on tirzepatide by North East and North Cumbria ICB almost tripled from June to September 2025, and most ICBs – including the lowest spenders – saw an upward trend throughout the last year.
Professor Azeem Majeed, head of the department of primary care and public health at Imperial College London, said: ‘These areas [that are spending the most on tirzepatide] have some of the highest levels of obesity, type 2 diabetes and socioeconomic deprivation in England, meaning there is a larger pool of people who meet the eligibility criteria set by NICE.’
The new GP contract, published on 24 February, looks to ‘boost’ access to weight loss jabs with £25m of financial incentives for GPs who support adults living with obesity.
But Dr Katie Bramall, chair of the BMA GPs committee, said: ‘Whilst the headlines promise much, in reality there will be no change to NHS England’s eligibility criteria for patients to access injectable weight‑loss medication on the NHS.
‘These proposals will do nothing over the next year to address the divide between those able to pay and those left waiting unable to afford private self-funded treatments.’
Last week MPs heard evidence collected by Pulse that weight-loss jabs are significantly adding to GP workload in a hearing of the Health and Social Care Committee on food and weight management.
A Pulse survey in September which found around one in 25 GP consultations now relate to Mounjaro was highlighted by witnesses advising MPs on how weight-loss jabs should be provided through the NHS.
Tirzepatide spend per ICB between April 2025 and November 2025
A version of this article was first published by Pulse’s sister title The Pharmacist
Click here to read the full investigation on The Pharmacist
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READERS' COMMENTS [3]
Please note, only GPs are permitted to add comments to articles
Many ICBs put a cap on how many patients each surgery could start on MJ. (Out of 11 who qualified we adopted a “fattest first” policy, referring the top 3 BMIs)
Of course, the “diabetic loophole” means that many obese diabetics are already on GLP drugs, whilst morbidly obese non-diabetic patients have to shell out hundreds a month for their MJ.
But even if the brakes are taken off prescribing, the “wrap around” service that is supposed to monitor MJ users will be rapidly overwhelmed, dumping responsibility on to GP surgeries, that will soon become a glorified weight loss service. As prescribing costs balloon, the impact on the NHS as a whole will be ruinous.
As unfair as the current 2 tier system is, it at least maintains costs, and keeps responsibility with the patient, not the Practice.(The current trend of classifying obesity as a “disease” thrusts responsibility away from the individual and on to the NHS) . Perhaps the poorer patients could be offered means-tested money-off vouchers to make MJ more affordable?
The utter failure of the NHS is undeniable by any rational person.
Millions of people in the UK might potentially benefit from these drugs, whilst the NHS can only offer them to a tiny fraction of that number.
Time to replace the NHS with something a bit less rubbish.
Dave Haddock-
Indulge me- is this ‘less rubbish’ alternative to the NHS you suggest going to come from existing funding? How will this alternative get these drugs to the clamouring millions in a safe and equitable way and what will it cost to administer vs adequately funding the NHS to do it?
The cost of running such models outside the NHS is visible – Or has it escaped you that these drugs are actually already available to millions under an alternative to the NHS. Its called reaching into your own pocket and feeling the opportunity cost of your own priorities yourself rather than the NHS having to trade off against other demands.