This interim policy statement outlines North East London’s (NEL) criteria for access to National Institute of Health and Care Excellence (NICE) approved weight management medications semaglutide (Wegovy®) and tirzepatide (Mounjaro)® on the NHS. It has been produced in line with NHS England Interim Commissioning Guidance working alongside our clinical experts and weight management services in North East London.
We are currently in the process of establishing new weight management services in NEL, in a phased approach. Tirzepatide will be made available on behalf of primary care as part of these services. We are working as quickly as possible to make these services available across North East London, over the next few months.
We will continue to update this policy statement and share information with local partners as we finalise our approach.
Further information about tirzepatide is available on the NHS England website and the National Clinical Institute for Excellence website.
Principles for Prescribing Wegovy® and Mounjaro® for Weight Management in NEL
- Equal Access: People who are living with obesity who are eligible for weight loss medications in line with this North East London Interim Policy Statement should have equitable access to these medicines
- Proactive Care: Weight management services will identify people living with obesity who are eligible for medication in line with this policy
- Financial Stewardship: We have a duty to live within our financial means, so prescribing and service costs must be managed within allocated budgets
Who will be eligible for Wegovy® or Mounjaro® on the NHS in North East London?
Those with a body mass index (BMI) greater than or equal to 40kg/m2 * and 4 or more qualifying co-morbidities. · Qualifying co-morbidities (see details of definitions and overleaf) are o Cardiovascular disease o Hypertension o Dyslipidaemia o Obstructive sleep apnoea o Type 2 diabetes mellitus
Those with a body mass index (BMI) greater than or equal to 35kg/m2 * and 1 weight related co-morbidity
(not restricted to qualifying co-morbidities) and one of the below criteria:
- Active malignancy and need for urgent weight loss for planned therapy e.g. radiotherapy or surgery
- Urgent weight loss needed for organ transplant
- Idiopathic intracranial hypertension (IIH), needing frequent lumbar punctures and/or visual compromise
- Undergoing planned time-sensitive surgery for life-limiting conditions, where a high BMI is the main barrier to surgery.
- Obesity hypoventilation syndrome (OHS)
* A lower body mass index threshold should be used (usually reduced by 2.5 kg/m2) for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic background
How will eligible people access Wegovy or Mounjaro on the NHS in North East London?
- In the next few months, GPs will be able to refer eligible people who meet the criteria above to a locally-commissioned specialist service to access weight management medicines on behalf of primary care. Referral criteria will be finalised in the next few weeks and communicated to primary care.
- All weight management services providing access to weight management medicines on the NHS to patients registered with a GP in North East London will comply with the eligibility and referral criteria for medicines as set out in this policy. This includes private providers with an NHS contract.
- For the locally-commissioned specialist service, initiation and ongoing prescribing and monitoring will be made available for primary care.
- Initiation of weight management medicines and ongoing monitoring and prescribing will be made available through specialist weight management services in NEL on behalf of primary care for people who are eligible in line with the criteria in this policy.
- People who are not yet eligible for weight management medicines on the NHS can access a wide range of other weight management services for support. We know there will be many people who do not qualify for the weight loss medications which may cause disappointment and / or exacerbate new and existing mental health and wellbeing issues. People may find NHS talking therapies a helpful source of support. For more information please see: Obesity - Treatment - NHS
Qualifying co-morbidities (see details of definitions)
| Qualifying co-morbidities | Definition |
|
Atherosclerotic cardiovascular disease (ASCVD) |
Established atherosclerotic CVD (ischaemic heart disease, cerebrovascular disease, peripheral vascular disease, heart failure) |
| Hypertension | Established diagnosis of hypertension and requiring blood pressure lowering therapy |
| Dyslipidaemia | Treated with lipid-lowering therapy, or with low-density lipoprotein (LDL) equal-to-or-greater than 4.1 mmol/L, or high-density lipoprotein (HDL) less than 1.0mmol/L for men or less than 1.3mmol/L for women or fasting (where possible) triglycerides equal-to-or-greater-than 1.7 mmol/L |
| Obstructive Sleep Apnoea (OSA) | Established diagnosis of OSA (sleep clinic confirmation via sleep study) and treatment indicated i.e. meets criteria for continuous positive airway pressure (CPAP) or equivalent |
| Type 2 diabetes mellitus | Established type 2 diabetes mellitus |
