Mounjaro on the NHS: the two different pathways (diabetes vs weight loss)

Why there are two pathways at all

Mounjaro is the brand name for tirzepatide, a once-weekly injection made by Eli Lilly that activates two gut-hormone receptors (GLP-1 and GIP). In the UK it holds two separate licensed uses: one for type 2 diabetes and one for managing overweight and obesity. NICE, the body that decides whether the NHS should fund a treatment, appraises each licensed use on its own. That is why tirzepatide has two different NICE technology appraisals — TA924 for diabetes and TA1026 for weight management. They were published at different times, have different eligibility rules, and are commissioned and prescribed through different parts of the NHS. Tirzepatide should only ever be started, titrated and monitored by a prescriber — this guide deliberately does not give doses.

Pathway 1 — TA924: Mounjaro for type 2 diabetes

NICE published TA924, “Tirzepatide for treating type 2 diabetes”, on 25 October 2023. It recommends tirzepatide as an option for adults with type 2 diabetes, but only when certain conditions are met. In summary, the guidance says it can be used when:

• Triple therapy has not worked: treatment with metformin and two other oral antidiabetic drugs is ineffective, not tolerated, or contraindicated; and
• A weight-related criterion applies — either a BMI of 35 kg/m² or more with specific psychological or other medical problems associated with obesity, or a BMI under 35 kg/m² where insulin therapy would have significant occupational implications, or where weight loss would benefit other significant obesity-related complications.

As with the weight-management route, the BMI thresholds are adjusted (usually reduced by 2.5 kg/m²) for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family backgrounds. This diabetes route is prescribed through normal NHS diabetes care rather than through the phased obesity programme described below. Your GP or diabetes team can tell you whether it is suitable for you.

Pathway 2 — TA1026: Mounjaro for weight management

NICE published TA1026, “Tirzepatide for managing overweight and obesity”, on 23 December 2024. The core NICE recommendation is that tirzepatide is an option for adults with an initial BMI of at least 35 kg/m² and at least one weight-related comorbidity, alongside a reduced-calorie diet and increased physical activity. NICE lists the qualifying comorbidities as high blood pressure, dyslipidaemia (abnormal blood fats), obstructive sleep apnoea, cardiovascular disease and type 2 diabetes. The BMI thresholds are reduced (usually by 2.5 kg/m²) for the same ethnic groups noted above, who can develop weight-related risks at a lower BMI.

Because the number of people who could benefit is very large, NHS England is not making the full eligible group available at once. Instead, access is being phased in, starting with those at highest clinical need. NHS England's interim commissioning guidance sets out the cohorts:

(BMI thresholds reduced by 2.5 kg/m² for the ethnic groups listed above.) The commissioning guidance covers roughly the first three years, with the eligible group continuing to widen in later phases. Tirzepatide for weight management can be prescribed within specialist weight-management services or in primary care, depending on local arrangements, and NHS England has added obesity indicators to the GP contract (QOF) from 2026/27 to help identify and support eligible patients.

The two pathways side by side

If you have type 2 diabetes and obesity, your clinician will decide which appraisal your treatment falls under — the criteria and funding routes are separate, so this is a decision for your GP, diabetes team or weight-management service, not something to work out alone.

What this means for you

• Start with your diagnosis. If your main issue is blood-sugar control in type 2 diabetes, the TA924 route is the relevant one; if it is weight, the TA1026 route applies.
• Eligibility is specific. Both pathways use defined BMI and comorbidity criteria — being overweight or having diabetes on its own does not guarantee access under either.
• The weight route is being phased. Where you are in the country and which cohort is open both affect when NHS tirzepatide for weight loss is available to you.
• Ask your prescriber. Only a GP, diabetes team or specialist weight-management service can confirm which pathway you qualify for and start treatment safely.

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