Private Mounjaro patients can only switch to NHS if they still meet criteria, GPs told

Patients accessing tirzepatide (Mounjaro) through a private provider can only switch to NHS treatment if they still meet the eligibility criteria, NHS England has told GP practices.

The commissioner told GPs that private patients looking to continue their treatment through the NHS will only be able to do so if they present with a BMI of 40 or higher, and four or more weight-related comorbidities, in line with commissioning guidance.

It comes as the price of tirzepatide in the UK for those accessing it privately is set to increase by 170% next month, with a month’s supply rising from £122 to £330. 

US-based Mounjaro manufacturer Eli Lilly said it had reached ‘an agreement with the UK government to increase the list price of Mounjaro, while maintaining access for NHS patients’. 

In a message to GPs, NHS England said: ‘For people that 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.’ 

The guidance further suggests primary care providers ‘could provide reassurance’ that stopping using tirzepatide does not cause withdrawal and should advise patients to continue a reduced-calorie diet and increased physical activity. 

Around 240,000 people are expected to be offered Mounjaro for obesity via the NHS over the next three years. However the rollout, which began in June, saw many ICBs unprepared to offer the service. 

GP in many parts of England had to explain to eligible patients that Mounjaro could not be prescribed in primary care yet, despite the NICE deadline having now passed.

It has also been estimated that there are already 1.5 million users of weight loss jabs in the UK, mostly through private providers. 

Tower Hamlets LMC member Dr Selvaseelan Selvarajah told Pulse there needs to be ‘appropriate’ resources and support for general practice if we are to shift all the patients from private to NHS and fulfil the requirements of NICE guidance.

He said: ‘Tirzepatide and other GLP-1s have led to significant positive changes for many of our patients. I have personally seen many patients lose the weight and improve their quality of life.  

‘It is very disappointing to see the drug companies increase the cost of the medication without full justification.  

‘We get several queries a week from patients asking about when GLPs will be available on the NHS for all those who are eligible.  

‘These queries are increasing but unfortunately, general practice doesn’t have the capacity provide this service currently so I would agree with the NHSE guidance.  

‘Ideally, there needs to be appropriate, permanent funding, resources and support for general practice if we are to shift all the patients from private to NHS and fulfil the requirements of NICE guidance.’

An NHS England spokesperson said: ‘The approved list price increase will not affect NHS commissioning of tirzepatide in England for eligible people living with obesity, based on clinical priority, or as a treatment for type 2 diabetes. 

‘Anyone with questions about their private tirzepatide prescription should contact their private provider.’

Earlier this month, an updated NICE quality standard said GPs should monitor patients who have taken weight-loss medication ‘for a minimum of one year’ after treatment is completed. 

The standard asks healthcare professionals including GPs to offer advice, follow-up support and provide tailored action plans including regular check-ins.  

In its own guidance for GPs, the BMA included a template letter for practices to push back against requests from private providers of weight loss medicines for patient information. 

Pulse has contacted the Department of Health and Social Care to comment.