NHS England expands tirzepatide eligibility to a second cohort

NHS England has opened a second phase of its rollout for tirzepatide, sold as Mounjaro, expanding who can get the drug through primary care. As of June 23, 2026, patients with a BMI of 35 to 39.9 — or 32.5 to 37.4 for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean backgrounds — can qualify, as long as they also have at least four of five specified long-term conditions ^[1].

Those qualifying conditions are type 2 diabetes, hypertension, dyslipidaemia (high cholesterol), established cardiovascular disease, and obstructive sleep apnoea ^[1]. This is being called "Cohort 2" of NHS England's phased rollout. It follows Cohort 1, which opened in June 2025 and covered patients with a BMI of 40 or above (37.5 with ethnic adjustment) who also had four or more of the same conditions ^[1]. A third cohort is scheduled to begin April 1, 2027, further loosening the comorbidity requirement to three or more conditions for patients with a BMI of 40 or above ^[1].

The phased approach is narrower than what the National Institute for Health and Care Excellence (NICE) has clinically recommended. NICE's guidance, Technology Appraisal TA1026, calls for tirzepatide to be available to adults with a BMI of at least 35 (32.5 with ethnic adjustment) who have just one weight-related condition, not four ^[1]. NHS England has restricted access beyond NICE's recommendation, citing capacity and funding limits, meaning many people who are technically eligible under NICE guidance still cannot get the drug through NHS primary care ^[1].

Adding another layer of complexity, NHS England moved tirzepatide prescribing into the 2026/27 GP contract on April 1, 2026, as an optional Quality and Outcomes Framework indicator ^[1]. That means individual GP practices choose whether to participate, and even patients who meet the BMI and comorbidity criteria may not get access if their local practice has opted out or their Integrated Care Board hasn't implemented the pathway ^[1]. NHS England has also asked patients not to contact their GP directly to request the injections; instead, eligible patients are supposed to be identified through GP records and contacted by their practice ^[1].

Why it matters for patients

For patients with a BMI in the 35 to 39.9 range who also manage multiple conditions like diabetes, high blood pressure and sleep apnoea, this expansion could open a path to NHS-funded tirzepatide that wasn't available a year ago ^[1]. But eligibility on paper does not guarantee treatment. Because GP practice participation is voluntary and rollout speed differs by Integrated Care Board, two patients with identical BMI and health histories in different parts of England could get very different answers ^[1].

Patients who meet NICE's broader clinical threshold — BMI 35 with just one qualifying condition — but fall short of the four-condition requirement under Cohort 2 remain outside NHS primary care access for now, even though NICE itself has recommended treatment for their situation ^[1]. Some people in this position have turned to private prescribers, where the BMI threshold is lower (30, or 27 with one condition) but the medication is not free ^[1].

What happens next

The next scheduled expansion is Cohort 3, set to begin April 1, 2027, which will drop the comorbidity requirement to three or more conditions for patients with a BMI of 40 or above (37.5 with ethnic adjustment), a group that already qualified under BMI in Cohort 1 but needed four conditions ^[1]. No date has been given in the sources for when NHS England might align its criteria fully with NICE's original, broader recommendation.