England plans to limit Mounjaro to about 220,000 NHS patients in first three years

England's health spending watchdog has recommended that Mounjaro, Eli Lilly's weight-loss drug, be offered to only about 220,000 people during the first three years of its rollout on the National Health Service. That is a small share of the roughly 3.4 million people who meet the medical criteria ^[1][2].

The recommendation from the National Institute for Health and Care Excellence (NICE) covers people with a body mass index above 35 who also have at least one weight-related illness ^[1][2]. About 3.4 million people in England fall into that group ^[1][2]. The Guardian reported that fewer than 10% of eligible patients will be able to get the drug on the NHS at first ^[1].

NICE called the slow rollout a "difficult decision" made "in order to protect other vital NHS services" ^[1]. NHS England requested that the medicine be rolled out over 12 years, according to the final draft guidance ^[1]. NICE said it will review the situation within three years and then provide further guidance ^[1].

Tirzepatide is sold as Mounjaro and is given as a once-weekly injection, intended to be prescribed alongside a reduced-calorie diet and exercise ^[1][2]. The Guardian described it as a glucagon-like peptide-1 (GLP-1) agonist and listed semaglutide — sold as Wegovy, Ozempic and Rybelsus — among other medicines in that family ^[1]. STAT described it as Eli Lilly's weight-loss drug and said patients would receive it "alongside a specialized, reduced calorie diet and increased physical activity" ^[2].

Prof Jonathan Benger, NICE's chief medical officer, said: "Tirzepatide and other drugs like it, such as semaglutide, will help people living with obesity to lose weight, and as a result will reduce their risk of developing heart disease or having a stroke. But tirzepatide is not for everybody, and only those with the highest clinical need will be treated initially. This means many people will have to wait." ^[1]

The two reports agree on the 220,000 figure, the 3.4 million eligible patients and the BMI threshold, but they carry different publication dates — STAT on Dec. 4, 2024, and The Guardian on Dec. 5, 2024 ^[1][2].

The Guardian also cited results from an Eli Lilly trial called SURMOUNT-5, in which patients on tirzepatide lost 20.2% of their body weight compared with 13.7% for patients on semaglutide ^[1]. It cited the Health Survey for England finding that 64% of adults were overweight or obese in 2022 ^[1]. Mounjaro was first given the green light to help manage obesity on the NHS in June as part of draft guidance from NICE, according to The Guardian ^[1].

Why it matters for patients

In England, meeting the medical criteria will not by itself guarantee access to Mounjaro. Priority goes to patients with the highest clinical need, starting with people already receiving care from specialist weight management services, who will be able to access the drug within 90 days of the guidance being published on 23 December ^[1]. Benger said many people will have to wait ^[1].

The reports do not say how patients outside specialist weight management services will be selected, or how long they might wait; NHS England is to develop a plan covering the other groups offered the drug over the next three years ^[1].

These reports describe England's publicly funded health system. They do not describe any restriction, coverage rule or waiting list for Mounjaro in the United States, and no US equivalent to this phased limit is mentioned in them ^[1][2].

The trial comparison between tirzepatide and semaglutide comes from a single study as reported by The Guardian; the reports do not include full details of that trial ^[1].

What happens next

NICE published final draft guidance, with the guidance due to be published on 23 December 2024, and patients in specialist weight management services able to access Mounjaro within 90 days of that date ^[1]. NHS England will develop a plan outlining which other groups of patients will be offered the drug during the next three years ^[1]. NICE will review the rollout within three years, while the funding variation sets a maximum rollout period of 12 years ^[1].