This information aims to provide information relating to tirzepatide (Mounjaro) as it is released from NHSE and in line with local implementation plans.

Introduction

Tirzepatide (Mounjaro) is a weight loss drug that, up to now, has only been prescribed for people with type 2 diabetes.

NICE published guidance on 23 December 2024 recommending that tripeptide (Mounjaro) be considered a treatment option for managing overweight and obesity, alongside a reduced-calorie diet and increased physical activity.

Tirzepatide (Mounjaro) criteria

Initially, because of the impact on services, NICE agreed that NHS England should publish criteria for the priority cohorts for Tirzepatide (Mounjaro).

Those priority cohorts are:

Year	Estimated Duration	Cohort	Cohort description (based on comorbidities)	BMI
1	12 months	i	more than 4 qualifying comorbidities	greater than 40
2	9 months	ii	more than 4 qualifying comorbidities	35-39.9
2/3	15 months	iii	3 qualifying comorbidities	greater than 40

The Qualifying Co-morbidities are as follows:

Qualifying Co-morbidities	Definition
Atherosclerotic Cardiovascular Disease (ASCVD)	Established ASCVD (ischaemic heart disease, cerebrovascular disease, peripheral vascular disease, heart failure)
Hypertension	Established diagnosis and requiring blood pressure lowering therapy
Dyslipidaemia	Treated with lipid-lowering therapy, or LDL lower than/equal to 4.1 mmol/L, or HDL lower than 1.0 mmol/L for men or HDL lower than 1.3mmol for women, or fasting triglycerides lower than/equal to 1.7 mmol/L
Obstructive Sleep Apnoea (OSA)	Established diagnosis of OSA (sleep clinic confirmation via sleep study) and treatment indicated i.e. CPAP or equivalent
Type 2 diabetes	Established diagnosis

Over time, these cohorts will be expanded to include the full criteria for tirzepatide (Mounjaro) which are:

People over the age of 18 who have a body mass index (BMI) of 35 or over (or a BMI of 32.5 for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds, as they are at a higher risk of medical problems at a lower BMI) and one of the above weight-related co-morbidities.

Weight loss injections are not suitable for patients who:

Have previously had weight loss surgery.
Are not engaging in NHS wrap-around care.

Please also see the product SmPC for a complete list of prescribing cautions and contraindications.

Wrap-around care

The NICE TA1026 mandates provision of wrap-around care alongside the prescribing of tirzepatide (Mounjaro). NHSE expects that this will incorporate nutritional and dietetic advice as a minimum and access to behavioural change components, as a mandatory requirement to access treatment.

Further information

BMA: Tirzepatide (Mounjaro) for weight management in General Practice

Private prescribing

NHS services are currently unable to support patients who buy weight loss injections and the ICB is not able to advise on a safe place to buy weight loss injections. We are aware that there are private providers who offer Tirzepatide; please be aware that some people may experience side effects, which may not be safely monitored by non-NHS providers. The private provider should offer a wrap-around service to support patients, and we would recommend that patients engage with this.

Online purchase

The UK medicines regulator, the Medicines and Healthcare products Regulatory Agency (MHRA) warns against buying weight loss medicines without a prescription.

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	Gliclazide 80 mg tab Pack of 28	£0.70	Sulfonylureas
	Sharps Bin 1 Litre Yellow Pack of 1	£0.98	Hypodermic equipment
	Metformin SR 500 mg SR Tab Pack of 56	£1.45	Biguanides
	Needle clipping / chopping device 1 device Pack of 1	£1.61	Hypodermic equipment
	Metformin SR 1000 mg SR tab Pack of 56	£1.83	Biguanides
	Urine Glucose Test Strips (Medi-Test Glucose) 1 pack (50 strips) Pack of 50	£2.36	Screening and Monitoring Agents
	Hypodermic insulin needles (Insupen Original) 4 mm/33gauge Pack of 100	£2.49	Hypodermic equipment
	Hypodermic insulin needles (Insupen Original) 4 mm/32gauge Pack of 100	£2.49	Hypodermic equipment
	Hypodermic insulin needles (Insupen Original) 5 mm/31gauge Pack of 100	£2.49	Hypodermic equipment
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	Hypodermic insulin needles (Microdot Max) 4 mm/32gauge insulin needles for pre-filled / reusable pen injectors screw on Pack of 100	£2.74	Hypodermic equipment
	Hypodermic insulin needles (GlucoRx CarePoint Ultra) 4 mm/32 gauge hypodermic insulin needles for pre-filled / reusable pen injectors screw on Pack of 100	£2.75	Hypodermic equipment
	Hypodermic insulin needles (GlucoRx CarePoint) 4 mm/31gauge hypodermic insulin needles for pre-filled / reusable pen injectors screw on Pack of 100	£2.75	Hypodermic equipment
	Hypodermic insulin needles (GlucoRx CarePoint) 5 mm/31gauge hypodermic insulin needles for pre-filled / reusable pen injectors screw on Pack of 100	£2.75	Hypodermic equipment
	Lancets sterile single use (Neon Verifine Safety ) 1.8 mm/28gauge Pack of 100	£2.99	Hypodermic equipment
Safety lancets are considerably more expensive than standard lancets; they should only be prescribed for patients who are unable to self-test and require assistance from a healthcare worker to obtain a blood sample. They should not be prescribed for patients who self-test.
	Lancets sterile single use (Neon Verifine Safety ) 1.8 mm/30gauge Pack of 100	£2.99	Hypodermic equipment
Safety lancets are considerably more expensive than standard lancets; they should only be prescribed for patients who are unable to self-test and require assistance from a healthcare worker to obtain a blood sample. They should not be prescribed for patients who self-test.
	Lancets sterile single use (GlucoRX Lancets) 0.31 mm / 30G Lancet Pack of 200	£4.50	Hypodermic equipment
	Blood glucose biosensor testing strips (On Call Extra) 50 test strips Pack of 50	£5.20	Screening and Monitoring Agents
	Blood Glucose Test Strips (CareSens S) 1 testing strips Pack of 50	£5.45	Screening and Monitoring Agents
	Blood glucose (True Metrix) 1 Metrix testing strips Pack of 50	£5.95	Screening and Monitoring Agents
	Blood glucose biosensor (Contour Plus) 1 testing strips Pack of 50	£5.95	Screening and Monitoring Agents
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	Blood glucose biosensor testing strips (AgaMatrix Agile) 1 testing strips Pack of 50	£5.99	Screening and Monitoring Agents
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	Glucose Gel (Glucogel) 40 % gel (80g pack) Pack of 80	£6.84	Treatment Of Hypoglycaemia
	Glucose Gel (Glucogel) 40 % gel (25g triple pack) Pack of 75	£7.16	Treatment Of Hypoglycaemia
	Insulin isophane human 10 units/ml suspension for injection 10ml vials Pack of 1	£7.48	Intermediate And Long-Acting Insulins
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As per national recommendations for gestational diabetes
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	Glucagon Injection (Glucagen Hypokit) 1 mg vial with prefilled syringe Pack of 1	£11.52	Treatment Of Hypoglycaemia
	Insulin lispro (Admelog ) 100 units/ml solution for injection 10ml vials Pack of 1	£14.12	Short-Acting Insulins
Will be discontinued by manufacturer in spring 2026. Clinicians should not initiate new patients on Admelog, which is a biosimilar insulin product. Advice regarding managing existing patients is available from the SPS.
	Apidra Vial 10 ml vial (100units/ml) Pack of 1	£16.00	Short-Acting Insulins
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	Humulin I Cartridge 3 ml Cartridge Pack of 5	£19.08	Intermediate And Long-Acting Insulins
	Humulin S Cartridge 3 ml Cartridge Pack of 5	£19.08	Short-Acting Insulins
	Insulin Aspart (Trurapi) 100 units/ml solution for injection 3ml cartridges Pack of 5	£19.82	Short-Acting Insulins
	Insulin lispro (Admelog ) 100 units/ml solution for injection 3ml cartridges Pack of 5	£21.23	Short-Acting Insulins
Will be discontinued by manufacturer in spring 2026. Clinicians should not initiate new patients on Admelog, which is a biosimilar insulin product. Advice regarding managing existing patients is available from the SPS.
	Insulin Aspart (Trurapi) 100 units/ml solution for injection 3ml pre-filled Solostar pens Pack of 5	£21.42	Short-Acting Insulins
	Humulin I Preloaded Pen 3 ml Disposable Pen (kwikpen) Pack of 5	£21.70	Intermediate And Long-Acting Insulins
	Humulin M3 Preloaded Pen 3 ml Disposable Pen (kwikpen) Pack of 5	£21.70	Intermediate And Long-Acting Insulins
	Insulin lispro (Admelog ) 100 units/ml solution for injection 3ml pre-filled pens Pack of 5	£22.10	Short-Acting Insulins
Will be discontinued by manufacturer in spring 2026. Clinicians should not initiate new patients on Admelog, which is a biosimilar insulin product. Advice regarding managing existing patients is available from the SPS.
	Insulin Isophane Human (Insulatard Penfill) 100 units/ml suspension for injection 3ml cartridge Pack of 5	£22.90	Intermediate And Long-Acting Insulins
Due to be discontinued, it is anticipated stock will run December 2025
	Hypodermic insulin needles (Microdot Dual) 4 mm/31gauge Safety Pen hypodermic insulin needles for pre-filled / reusable pen injectors screw on Pack of 100	£22.95	Hypodermic equipment
Only to be prescribed for adults having insulin administered by a third party such as District Nursing teams and Care home staff.
	Apidra SoloStar 3 ml prefilled pen Pack of 5	£28.30	Short-Acting Insulins
	Insulin Lispro Cartridge (Humalog) 3 ml Cartridge Pack of 5	£28.31	Short-Acting Insulins
	NovoMix 30 Cartridge (Penfill) 3 ml penfill cartridge Pack of 5	£28.79	Intermediate And Long-Acting Insulins
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	Insulin Lispro Kwik Pen (Humalog) 100 units/ml solution for injection 3ml pre-filled disposable injection Pack of 5	£29.46	Short-Acting Insulins
	NovoMix 30 Prefilled Pen (FlexPen ) 3 ml pre-filled pen Pack of 5	£29.89	Intermediate And Long-Acting Insulins
	Humalog Mix25 Prefilled Pen 3 ml Disposable Pen Pack of 5	£30.98	Intermediate And Long-Acting Insulins
	Insulin glargine (Abasaglar) 100 units/ml solution for injection 3ml cartridges Pack of 5	£35.28	Intermediate And Long-Acting Insulins
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	Tirzepatide (Mounjaro KwikPen) 2.5 mg/0.6ml solution for injection (2.4ml pre-filled pens) Pack of 1	£133.00	Other Antidiabetics
Tirzepatide can be initiated in primary care for people with type 2 diabetes as per NICE TA924 criteria. Secondary care virtual referrals may be used for patients with existing retinopathy or complex issues. Tirzepatide may also be prescribed in primary care for managing overweight and obesity, for patients who meet the NHSE criteria for funding as per NICE TA1026.
	Tirzepatide (Mounjaro KwikPen) 5 mg/0.6ml solution for injection (2.4ml pre-filled pens) Pack of 1	£180.00	Other Antidiabetics
Tirzepatide can be initiated in primary care for people with type 2 diabetes as per NICE TA924 criteria. Secondary care virtual referrals may be used for patients with existing retinopathy or complex issues. Tirzepatide may also be prescribed in primary care for managing overweight and obesity, for patients who meet the NHSE criteria for funding as per NICE TA1026.
	Tirzepatide (Mounjaro KwikPen) 7.5 mg/0.6ml solution for injection (2.4ml pre-filled pens) Pack of 1	£255.00	Other Antidiabetics
Tirzepatide can be initiated in primary care for people with type 2 diabetes as per NICE TA924 criteria. Secondary care virtual referrals may be used for patients with existing retinopathy or complex issues. Tirzepatide may also be prescribed in primary care for managing overweight and obesity, for patients who meet the NHSE criteria for funding as per NICE TA1026.
	Tirzepatide (Mounjaro KwikPen) 10 mg/0.6ml solution for injection (2.4ml pre-filled pens) Pack of 1	£255.00	Other Antidiabetics
Tirzepatide can be initiated in primary care for people with type 2 diabetes as per NICE TA924 criteria. Secondary care virtual referrals may be used for patients with existing retinopathy or complex issues. Tirzepatide may also be prescribed in primary care for managing overweight and obesity, for patients who meet the NHSE criteria for funding as per NICE TA1026.
	Tirzepatide (Mounjaro KwikPen) 12.5 mg/0.6ml solution for injection (2.4ml pre-filled pens) Pack of 1	£330.00	Other Antidiabetics
Tirzepatide can be initiated in primary care for people with type 2 diabetes as per NICE TA924 criteria. Secondary care virtual referrals may be used for patients with existing retinopathy or complex issues. Tirzepatide may also be prescribed in primary care for managing overweight and obesity, for patients who meet the NHSE criteria for funding as per NICE TA1026.
	Tirzepatide (Mounjaro KwikPen) 15 mg/0.6ml solution for injection (2.4ml pre-filled pens) Pack of 1	£330.00	Other Antidiabetics
Tirzepatide can be initiated in primary care for people with type 2 diabetes as per NICE TA924 criteria. Secondary care virtual referrals may be used for patients with existing retinopathy or complex issues. Tirzepatide may also be prescribed in primary care for managing overweight and obesity, for patients who meet the NHSE criteria for funding as per NICE TA1026.
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	Sitagliptin 25 mg tablets Pack of 28	£2.07	Other Antidiabetics
	Sitagliptin 100 mg tablets Pack of 28	£2.32	Other Antidiabetics
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	Pioglitazone 30 mg tab Pack of 28	£3.42	Other Antidiabetics
	Pioglitazone 15 mg tab Pack of 28	£3.67	Other Antidiabetics
	Pen Needles (GlucoRX FinePoint) 4 mm / 31G Pack of 100	£4.50	Hypodermic equipment
	Pen Needles (GlucoRX FinePoint) 5 mm / 31G Pack of 100	£4.50	Hypodermic equipment
	Sterile Lancets (AgaMatrix Ultra Thin) 0.2 mm / 33G Pack of 200	£5.43	Hypodermic equipment
	Sterile Lancets (AgaMatrix Ultra Thin) 0.35 mm / 28G Pack of 200	£5.43	Hypodermic equipment
	Lancets sterile single use (GlucoRx Safety lancets) 1.6 mm/30 gauge lancet Pack of 100	£5.50	Hypodermic equipment
Safety lancets are considerably more expensive than standard lancets; they should only be prescribed for patients who are unable to self-test and require assistance from a healthcare worker to obtain a blood sample. They should not be prescribed for patients who self-test.
	Lancets sterile single use (GlucoRx Safety lancets) 1.8 mm/26 gauge lancet Pack of 100	£5.50	Hypodermic equipment
Safety lancets are considerably more expensive than standard lancets; they should only be prescribed for patients who are unable to self-test and require assistance from a healthcare worker to obtain a blood sample. They should not be prescribed for patients who self-test.
	Lancets sterile single use (GlucoRx Safety lancets) 1.8 mm/28 gauge lancet Pack of 100	£5.50	Hypodermic equipment
Safety lancets are considerably more expensive than standard lancets; they should only be prescribed for patients who are unable to self-test and require assistance from a healthcare worker to obtain a blood sample. They should not be prescribed for patients who self-test.
	Lancets sterile single use (GlucoRx Safety lancets) 2.2 mm/23 gauge lancet Pack of 100	£5.50	Hypodermic equipment
Safety lancets are considerably more expensive than standard lancets; they should only be prescribed for patients who are unable to self-test and require assistance from a healthcare worker to obtain a blood sample. They should not be prescribed for patients who self-test.
	Blood glucose biosensor testing strips (Palmdoc Testing Strips) 50 Blood glucose biosensor testing strips Pack of 50	£5.90	Screening and Monitoring Agents
Not included in national recommendations, not for new initiations.
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	Alogliptin (Vipidia) 12.5 mg tablets Pack of 28	£26.60	Other Antidiabetics
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Ertugliflozin as monotherapy or with metformin for treating type 2 diabetes as per NICE TA572
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May only be initiated in primary care for people with type 2 diabetes and no heart failure.
	Canagliflozin (Invokana) 300 mg tab Pack of 30	£39.20	Other Antidiabetics
May only be initiated in primary care for people with type 2 diabetes and no heart failure.
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To be prescribed by brand name due to differences in product licence
	Dapagliflozin 10 mg tablets Pack of 28	£7.22	Other Antidiabetics Other Antidiabetics
May be initiated in primary care for people with type 2 diabetes and no heart failure and for use in the management of CKD as per NICE TA1075. Dapagliflozin remains as specialist recommended in the treatment of chronic heart failure (with or without T2D) in line with NICE TA679. Please note - a starting dose of 5mg is only to be used in cases of severe hepatic impairment, this may be increased to 10mg if well tolerated.
	Dapagliflozin 5 mg tablets Pack of 28	£7.58	Other Antidiabetics Other Antidiabetics
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	Empagliflozin (Jardiance) 10 mg tab Pack of 28	£36.59	Other Antidiabetics Other Antidiabetics
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	Empagliflozin (Jardiance) 25 mg tab Pack of 28	£36.59	Other Antidiabetics Other Antidiabetics
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	Semaglutide (Rybelsus) 4 mg tabs (New Formulation) Pack of 30	£78.48	Other Antidiabetics
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	Semaglutide (Rybelsus) 9 mg tabs (New Formulation) Pack of 30	£78.48	Other Antidiabetics
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	Glucose detection sensor (Dexcom One+) 1 kit Pack of 1	£24.97	Screening and Monitoring Agents
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	Insulin aspart (Fiasp Penfill) 100 units/ml solution for injection 3ml cartridges Pack of 5	£28.31	Short-Acting Insulins
Fiasp (Fast acting insulin aspart) for patients 1 year and over under the care of the paediatric diabetes service, who are either unpredictable eaters or have problematic post-meal glucose rise, not managed with dietetic input and assessed as competent to try Fiasp by the dietician.
	Glucose interstitial detection sensor (FreeStyle Libre 2 Plus Sensor) 1 sensor kit Pack of 1	£37.50	Screening and Monitoring Agents
Commissioned for all people (both adults and children) with type 1 diabetes who have been assessed by their specialist to meet the prevailing CIOS ICB criteria. This product will be replacing the Freestlye Libre 2 from July 2024. Please note this is a 15 day sensor
	Glucose interstitial detection sensor (FreeStyle Libre 3 Plus Sensor) 1 sensor kit Pack of 1	£45.00	Screening and Monitoring Agents
Only to be prescribed in primary care following a request from the RCHT diabetes team for people with type 1 diabetes alongside the mylife Ypsopump and CamAPS FX (MyLife) algorithm as part of a hybrid closed loop (HCL) system. May also be requested by secondary care teams for use as part of a hybrid closed-loop system in pregnancy in line with NICE TA943. Not to be prescribed as a standalone CGM. This product will be replacing the freestyle libre 3 from Dec 2025. Please note this is a 15 day sensor.
	Insulin Degludec (Tresiba) 100 u / ml (3ml cartridge) (Penfill) Pack of 5	£46.60	Intermediate And Long-Acting Insulins
Approved for use in the treatment of type 1 diabetes mellitus in adults, adolescents and children from the age of one year, who are under the care of the paediatric diabetes service
	Midodrine (Bramox) 2.5 mg tablets Pack of 100	£55.05	Treatment of diabetic nephropathy and neuropathy
	Insulin Degludec (Tresiba Flextouch) 200 u/ml (3ml prefilled pen) Pack of 3	£55.92	Intermediate And Long-Acting Insulins
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	Midodrine (Bramox) 5 mg tablets Pack of 100	£75.05	Treatment of diabetic nephropathy and neuropathy
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	Semaglutide (Wegovy FlexTouch) 0.25 mg/0.37ml solution for injection 1.5ml pre-filled pens Pack of 1	-	Other Antidiabetics
Prescribing to remain within secondary care specialist weight management service as per NICE TA 875
	Semaglutide (Wegovy FlexTouch) 0.5 mg/0.37ml solution for injection 1.5ml pre-filled pens Pack of 1	-	Other Antidiabetics
Prescribing to remain within secondary care specialist weight management service as per NICE TA 875
	Semaglutide (Wegovy FlexTouch) 1 mg/0.75ml solution for injection 3ml pre-filled pens Pack of 1	-	Other Antidiabetics
Prescribing to remain within secondary care specialist weight management service as per NICE TA 875
	Semaglutide (Wegovy FlexTouch) 1.7 mg/0.75ml solution for injection 3ml pre-filled pens Pack of 1	-	Other Antidiabetics
Prescribing to remain within secondary care specialist weight management service as per NICE TA 875
	Semaglutide (Wegovy FlexTouch) 2.4 mg/0.75ml solution for injection 3ml pre-filled pens Pack of 1	-	Other Antidiabetics
Prescribing to remain within secondary care specialist weight management service as per NICE TA 875
	Liraglutide injection (Saxenda ) 6 mg/ml solution for injection 3ml pre-filled pen Pack of 5	-	Other Antidiabetics
To be prescribed via specialist weight management service only
	Ocrelizumab (Ocrevus) 300 mg/10ml concentrate for solution for infusion vials Pack of 1	-	Hypodermic equipment
	Metformin 1 g tab Pack of 28	£6.03	Biguanides
	Glucose Test Strips (Accu-Chek Aviva) 50 Test Strips Pack of 50	£12.99	Screening and Monitoring Agents
For type 1 pump patients only. Not for initiation in primary care
	Blood Glucose Test Strips (Contour Next) 50 test strips Pack of 50	£16.21	Screening and Monitoring Agents
	Blood Glucose Test Strips (Freestyle Optium) 50 Test Strips Pack of 50	£16.30	Screening and Monitoring Agents
	Diabetes test strips (Freestyle Optium Beta Ketone) 10 test strips Pack of 10	£21.94	Screening and Monitoring Agents
For type 1 paediatric patients who are unable to use a separate ketone meter.
	Blood Glucose Needles (BD Autoshield Duo) 5 mm / 30G Pack of 100	£30.08	Hypodermic equipment
All children who attend school should be prescribed BD Autoshield needles to minimise the risk of needle stick injuries. These needles should be added to repeat prescriptions in ADDITION to universal needles, as the Autoshield is required only for school use, not home use.
	Sitagliptin / Metformin (Janumet) 50 mg / 1000mg tab Pack of 56	£33.26	Other Antidiabetics
	Dulaglutide (Trulicity) 0.75 mg/0.5ml solution for injection pre-filled pen disposable injection Pack of 4	£73.25	Other Antidiabetics
Dulaglutide (Trulicity) is only to be prescribed for patients already on treatment. Please do not initiate new patients on this medication.
	Dulaglutide (Trulicity) 1.5 mg/0.5ml solution for injection pre-filled pen disposable injection Pack of 4	£73.25	Other Antidiabetics
Dulaglutide (Trulicity) is only to be prescribed for patients already on treatment. Please do not initiate new patients on this medication.
	Dulaglutide (Trulicity) 3 mg/0.5ml solution for injection pre-filled pen disposable injection Pack of 4	£73.25	Other Antidiabetics
Dulaglutide (Trulicity) is only to be prescribed for patients already on treatment. Please do not initiate new patients on this medication.
	Dulaglutide (Trulicity) 4.5 mg/0.5ml solution for injection pre-filled pen disposable injection Pack of 4	£73.25	Other Antidiabetics
Dulaglutide (Trulicity) is only to be prescribed for patients already on treatment. Please do not initiate new patients on this medication.