Mounjaro on the NHS: NICE Guidance, Eligibility and the Rollout

Mounjaro (tirzepatide) is available on the NHS, but access is being phased in over several years rather than offered to everyone who meets NICE's criteria at once. NICE recommended it for weight management in technology appraisal TA1026 (December 2024) for adults with a BMI of at least 35 and at least one weight-related condition. In England, GP prescribing began in June 2025 for people with a BMI of 40 or more and at least four of five qualifying conditions, and was extended in June 2026 to people with a BMI of 35 to 39.9 who also have four or more. Lower BMI thresholds apply to some ethnic groups, local arrangements vary, and Scotland, Wales and Northern Ireland have their own processes.

This guide explains what NICE recommended, how the rollout works, who is eligible at the time of writing, what to expect from NHS treatment and what your options are if you are not yet eligible. For an overview of the medicine itself, see our complete guide to Mounjaro in the UK or the Mounjaro hub.

What NICE recommended

NICE's technology appraisal TA1026, published in December 2024, recommends tirzepatide as an option for managing overweight and obesity in adults, alongside a reduced-calorie diet and increased physical activity, if they have:

• an initial BMI of at least 35 kg/m², and
• at least one weight-related comorbidity.

NICE also recommends using lower BMI thresholds, usually reduced by 2.5 kg/m², for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family backgrounds, who tend to face higher health risks at lower BMIs. See lower BMI thresholds for South Asian, Chinese, Black African and Caribbean people.

TA1026 also advises that if less than 5% of initial weight has been lost after six months on the highest tolerated dose, the prescriber should decide whether to continue, taking into account the person's wider clinical picture.

Unlike NICE's earlier guidance on semaglutide (Wegovy), TA875, which limits NHS treatment to a maximum of two years within specialist weight-management services, TA1026 does not set a maximum treatment duration and allows prescribing in primary care.

How NICE's criteria compare with the licence

The MHRA licence is wider than NICE's recommendation. Understanding the difference explains why some people can be prescribed Mounjaro privately but are not yet eligible on the NHS.

Why the rollout is phased

NICE estimated that a very large number of people in England could be eligible under TA1026, potentially several million. Normally, the NHS must make a NICE-recommended medicine available within 90 days. In this case, NICE agreed a "funding variation" allowing NHS England to phase in access over a much longer period, reflecting the scale of demand, the need for GP capacity and wraparound care, and the cost to the NHS.

NHS England published interim commissioning guidance setting out the order in which groups would become eligible, starting with those with the highest clinical need. It estimated that around 220,000 people could be treated in the first three years.

Who is eligible, and when

The phased approach is based on two things: your BMI and how many of five qualifying weight-related conditions you have.

The five qualifying conditions

1. Type 2 diabetes
2. Hypertension (high blood pressure)
3. Dyslipidaemia (abnormal levels of blood fats such as cholesterol or triglycerides)
4. Obstructive sleep apnoea
5. Established atherosclerotic cardiovascular disease (for example, ischaemic heart disease, a previous stroke or peripheral arterial disease)

The cohorts

Based on NHS England's interim commissioning guidance and published local NHS information at the time of writing. Later cohorts and dates may change; check with your GP practice or local integrated care board (ICB).

Further cohorts are expected in later years, eventually covering the full population described in TA1026. NICE has said it will review the access criteria as the rollout progresses.

Local variation

Integrated care boards (ICBs) organise how the rollout works locally. In some areas, GP practices proactively search their records for eligible patients and invite them; in others, patients may need to ask. Arrangements also changed during 2026 in some areas as provision moved into mainstream GP services. Not every practice participates in the same way, so it is worth asking your practice how it operates.

Scotland, Wales and Northern Ireland

Health is devolved, and each nation makes its own arrangements for NICE guidance and new medicines. In Scotland, medicines are assessed by the Scottish Medicines Consortium. Eligibility criteria and timescales may differ from England, so check with your GP practice or local health board.

What NHS treatment involves

Assessment

Before prescribing, your GP practice will usually:

• confirm your BMI with a measured weight and height
• check which qualifying conditions you have, using your records and any necessary tests
• review your other medicines and medical history for reasons tirzepatide might not be suitable, such as pregnancy plans, previous pancreatitis or certain gastrointestinal conditions
• discuss the benefits, side effects and commitment involved

Wraparound care

NICE and NHS England require tirzepatide to be prescribed with wraparound care, covering:

• advice on healthy eating and nutrition
• support to increase physical activity
• help with making long-term behavioural changes

This may be delivered in person, in groups or digitally, depending on your area.

Dosing and monitoring

NHS treatment follows the same dosing as the licence: 2.5mg weekly for four weeks, then increases in 2.5mg steps at intervals of at least four weeks, up to a maximum of 15mg. Your practice will review your progress, side effects and any changes needed to other medicines, such as diabetes treatments. See Mounjaro doses explained.

The six-month review

In line with TA1026, if you have lost less than 5% of your starting weight after six months on the highest dose you can tolerate, your prescriber will discuss whether to continue.

Collecting your prescription

NHS prescriptions for tirzepatide are usually dispensed by community pharmacies. In England, the standard prescription charge applies unless you are exempt; in Scotland, Wales and Northern Ireland, prescriptions are free. When Eli Lilly raised the UK list price for private supply in September 2025, Community Pharmacy England and the Department of Health and Social Care confirmed NHS reimbursement arrangements so that pharmacies could keep dispensing NHS prescriptions. NHS patients did not pay more as a result.

What to expect at your first NHS appointment

The first appointment is usually a conversation to check eligibility and suitability rather than an immediate prescription. Depending on your practice, it may involve a GP, practice nurse, clinical pharmacist or another member of the team. You may be asked to:

• have your weight, height and blood pressure measured
• have blood tests if recent results are not available, for example to check blood sugar, cholesterol and kidney function
• discuss your medical history, including any history of pancreatitis, gallbladder problems, eating disorders or diabetic eye disease
• review your current medicines, including contraception
• talk about your goals, previous attempts to manage your weight and what support you would like

You may then be referred to a wraparound care service before or alongside your first prescription.

Wraparound care in practice

Wraparound care varies by area. It may be delivered by the practice, a local weight-management service or a digital programme approved by the ICB. Typical elements include:

• structured advice on reduced-calorie eating that suits a smaller appetite
• guidance on protein, fibre and hydration
• support to build physical activity, including strength work
• behavioural support, such as setting goals and managing cravings or emotional eating

Engaging with this support is a condition of NHS treatment in many areas, and it can also help with long-term maintenance.

If you are told you are not eligible

If your practice says you do not currently meet the criteria, you can ask:

• which cohort you would fall into and when that cohort is expected to open
• whether any of your conditions are not recorded in your notes
• what other local support is available in the meantime

If you believe a qualifying condition has been missed, your practice can review your records and arrange any tests needed.

How to ask your GP about Mounjaro

If you think you might be eligible:

1. Check your BMI using our BMI calculator, remembering that the NHS will use a measured value.
2. List your conditions. Do you have any of the five qualifying conditions?
3. Contact your practice and ask whether it is offering tirzepatide for weight management and how to be assessed.
4. Be prepared for questions about your medical history, medicines and goals.

Our eligibility checker can help you understand where you might fit, but it is informational only and cannot tell you whether you will be prescribed treatment.

If you are not eligible yet

Not being eligible under the current cohort does not mean there is no help available.

• NHS weight management services. Many areas offer behavioural weight management programmes, and some offer specialist weight management services that can consider other treatments, including Wegovy under TA875. See Wegovy on the NHS.
• NHS Digital Weight Management Programme. In England, people with a BMI of 30 or more (27.5 for some ethnic groups) and diabetes or high blood pressure may be referred by their GP.
• Bariatric surgery. For some people with severe obesity, surgery remains the most effective long-term option. See GLP-1 medication vs bariatric surgery.
• Private treatment. Many people who meet the MHRA licence criteria but not the current NHS criteria are treated privately. See Private vs NHS weight loss treatment and Who can get weight loss injections in the UK?.

A short timeline of tirzepatide access in the UK

Dates reflect information available at the time of writing. Check NHS England, your ICB or your GP practice for current arrangements.

Common questions about NHS eligibility

What counts as cardiovascular disease?

The rollout refers to established atherosclerotic cardiovascular disease. This generally means conditions caused by narrowed or blocked arteries, such as angina, a previous heart attack, a previous stroke or transient ischaemic attack, or peripheral arterial disease. Your GP will confirm what is recorded in your notes.

What if I have conditions that are not on the list?

NICE TA1026 refers to weight-related comorbidities more broadly, but the NHS England rollout uses the five specified conditions to decide priority. Other conditions, such as osteoarthritis or fatty liver disease, may still be relevant to your overall care but do not currently count towards the cohort criteria. This may change in later phases.

I am already taking Wegovy through a specialist service. Can I switch?

Decisions about switching between medicines on the NHS are made by your specialist team or GP, based on your clinical situation and local arrangements. See Switching from Wegovy to Mounjaro.

What happens if I move to a different area?

Because ICBs organise local services, arrangements may differ between areas. If you move, register with a new GP practice promptly and tell them you are taking tirzepatide so that your care can continue.

Comparing NHS and private routes

For private options, our providers page compares regulated services on safety checks and support, and our Mounjaro prices page explains what affects private cost. See also our Mounjaro price guide.

Moving from private to NHS treatment

If you start privately and later become eligible on the NHS, your GP will assess you against the NHS criteria at that time. How a BMI measured after some weight loss is treated may depend on local policy, and practices may ask for evidence of your starting BMI. Ask your practice how it handles this before assuming you can transfer.

When to speak to a professional

Speak to your GP practice:

• to find out whether you are eligible under the current NHS criteria
• if you have any of the qualifying conditions and are struggling with your weight
• before starting private treatment, so your medical records are complete
• if you are taking Mounjaro and are planning a pregnancy, have new symptoms or are due to have surgery

Seek urgent medical help (NHS 111, or 999 in an emergency) if, while taking Mounjaro, you have:

• severe, persistent abdominal pain, which may spread to your back, with or without vomiting
• pain in the upper right abdomen with fever or yellowing of the skin or eyes
• signs of severe dehydration, such as very little urine, dizziness or confusion
• swelling of the face, lips or throat, or difficulty breathing