Prescribing activity of Tirzepatide (Mounjaro®) in primary care settings for the purpose of weight management as per the NICE funding variation

Following a National Institute for Health and Care Excellence (NICE) Technology Appraisal (TA) publication (TA1026) on 23 December 2024, tirzepatide (Mounjaro®) was recommended for managing overweight and obesity, alongside a reduced-calorie diet and increased physical activity in adults. There is an established eligibility criteria as per the NICE funding variation that prescribing clinicians will need to adhere to. NHS England submitted a funding variation request, on behalf of NHS providers and the ICBs, to extend the time needed to comply with the recommendations. 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.

NHS England published the Interim Commissioning Guidance which provides a framework for commissioners to implement the NICE TA and NICE funding variation. The guidance details the eligible patient cohorts in all the care settings and the prioritisation strategy to support a phased implementation of tirzepatide (Mounjaro®) across primary care settings.

An initial implementation phase of up to three years will apply to a subset of the eligible population. This period will be used to test delivery approaches and to put in place the arrangements required to safely and efficiently scale different service models, including digital patient support. NICE will review evidence generated during this initial phase within the first three years of implementation and will consider whether to amend the overall 12 year implementation timeframe and whether NHS England should issue a revised interim commissioning policy for the remaining period.

The purpose of this reporting request is to:

• collate the appropriate aggregated data for the reporting period from Integrated Care Boards (ICBs) in relation to the prescription of tirzepatide (Mounjaro®) in primary care settings
• to ensure prescribing aligns with the initial cohorts for access outlined in the interim commissioning guidance. The cohorting approach can be found in the appendix. 
• to support in any onward reporting requests and inform future financial allocations

For UK GDPR purposes NHS England’s lawful basis for processing when directed by the Secretary of State is article 6(1)(d) – processing is necessary to protect the vital interests of the data subject or of another natural person.

The initial clinical definitions for comorbidities were derived from randomised clinical trial cohort definitions to ensure they were based on evidence-based research. NHS England further refined these definitions 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.

The qualifying comorbidities are:

• atherosclerotic cardiovascular disease (ASCVD)
• hypertension
• dyslipidaemia
• obstructive sleep apnoea (OSA)
• type 2 diabetes

Full definitions of these comorbidities can be found in the appendix.