NHS England opens tirzepatide access to a second, lower-BMI patient group

Starting June 23, 2026, NHS England expanded primary care eligibility for tirzepatide, sold in the UK as Mounjaro, to a second group of patients: adults with a BMI of 35 to 39.9 — or 32.5 to 37.4 with an ethnic adjustment — who also have at least four qualifying long-term conditions ^[1].

The step is the second stage of a phased rollout. The first cohort, active since June 2025, was limited to people with a BMI of 40 or above plus four or more qualifying conditions ^[1]. The five conditions counted for either cohort are type 2 diabetes, hypertension, dyslipidaemia (high cholesterol), established cardiovascular disease and obstructive sleep apnoea ^[1]. A third cohort, scheduled for April 1, 2027, would open access to people with a BMI of 40 or above who have three or more of those conditions ^[1].

For people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean backgrounds, BMI thresholds are lowered by 2.5 kg/m² across both NHS and private routes, reflecting evidence of higher metabolic risk at lower BMIs ^[1]. That is why the new cohort's range reads 32.5 to 37.4 rather than 35 to 39.9 ^[1].

The expansion remains narrower than the clinical guidance from NICE, whose Technology Appraisal TA1026 recommends tirzepatide for adults with a BMI of at least 35 (32.5 with the ethnic adjustment) and at least one weight-related condition ^[1]. NHS England has narrowed primary care access because of capacity and funding constraints, and the published guidance states that being NICE-eligible does not automatically mean being eligible through NHS primary care ^[1].

Since April 1, 2026, tirzepatide prescribing has sat inside the 2026/27 GP contract as an optional Quality and Outcomes Framework indicator ^[1]. Participation by GP practices is voluntary, so not every practice will prescribe the drug even for patients who meet the criteria, and access varies by Integrated Care Board area ^[1]. NHS England has asked patients not to contact their GP to request weight loss injections; eligible patients are identified through GP records and contacted directly ^[1]. Meeting the criteria therefore does not guarantee treatment ^[1].

Private treatment through a GPhC-registered pharmacy remains available to a wider group: adults with a BMI of 30 or above, or 27 or above with one weight-related health condition — 27.5 and 24.5 respectively with the ethnic adjustment ^[1]. Private costs rose across UK providers after Eli Lilly's September 2025 wholesale price increase for Mounjaro, and pricing varies depending on whether a provider has signed Lilly's rebate program and what a quote includes ^[1].

Why it matters for patients

The change applies to NHS England primary care and does not alter US insurance coverage or US prescribing rules for tirzepatide.

What it shows is how far apart a drug's clinical recommendation and actual paid access can sit. NICE's guidance covers adults with a BMI of at least 35 and one related condition, while NHS England's primary care cohorts cover a narrower slice of that same group, and individual GP practices decide whether to take part at all ^[1]. A UK patient who meets NICE's threshold but not the current cohort criterion has to wait for a later cohort to activate ^[1].

The ethnic adjustment is another feature US readers may not encounter in the same form: the 2.5 kg/m² reduction applies in the UK to people from six listed ethnic backgrounds, on both NHS and private routes ^[1]. How or whether comparable adjustments are applied in the US is not addressed in the published cohorts.

One practical limit is already visible. Under the April 2026 contract change, eligibility and access are separate questions — a practice can decline to prescribe, and local arrangements differ by area ^[1].

The number of additional patients the June 23 expansion covers, how quickly they will be identified and contacted, and the funding behind the rollout have not been reported.

What happens next

• April 1, 2027: the third primary care cohort is scheduled to open, covering people with a BMI of 40 or above who have three or more qualifying conditions ^[1].

No date has been disclosed for any further expansion beyond that cohort ^[1].