As outlined in the NHS Interim Commissioning Guidance, (click link to download) tirzepatide (Mounjaro) will be introduced through a phased approach focused on clinical prioritisation. Eligibility is determined by BMI thresholds and weight-related comorbidities, including:

• Atherosclerotic CVD - IHD, CVA/TIA, PAD, HF
• Hypertension - On treatment
• Dyslipidaemia - On LLT OR LDL >=4.1 OR HDL <1.0 for men or HDL <1.3 women OR fasting (where possible) triglycerides >=1.7
• Obstructive Sleep Apnoea (OSA) - Meets criteria for CPAP or equivalent
• Diabetes Type 2  - May meet criteria for treatment with DM2 alone

Phased Primary Care Cohorts (2025–2028)

• Cohort I (2025-26 ): 4 or more comorbidities and BMI ≥40
• Cohort II (2026-27): 4 or more comorbidities and BMI 35-39.9
• Cohort III (2026-2028): 3 or more comorbidities and BMI ≥40

BMI thresholds should be reduced by 2.5 kg/m² for specified ethnicities, including South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnicity

Primary Care Responsibilities
If commissioned to deliver the pathway, GP practices may be responsible for:

• Confirming eligibility using clinical records

• Providing patients with at least 9 months of wraparound support, either locally or via the nationally commissioned service

• Monthly face-to-face reviews during titration

• Structured medication reviews over a minimum of 12 months

• Complying with local prescribing governance, such as prior approval systems

• Coordinating with wraparound service providers where appropriate