Îʶ¦ÓéÀÖ

Status:

Action.

Category:

Workforce/public health.

Title:

Tirzepatide (Mounjaro®) for the management of obesity and overweight.

Summary:

Letter to health boards, general practitioners and pharmacies on the use of Tirzepatide (Mounjaro®) in weight management.

Date of expiry / review:

1 July 2025.

Action by:

Local health boards.

Required by:

With immediate effect.

Sender:

• Sioned Rees, Director of Public Health, Îʶ¦ÓéÀÖ Government.
• Andrew Evans, Chief Pharmaceutical Officer, Îʶ¦ÓéÀÖ Government.

Îʶ¦ÓéÀÖcontacts:

Anwen Jones,
Healthy and Active Branch,
Health Improvement, Prevention and Inequalities,
Public Health Division.

Enclosures:

None.

Dear Colleagues,

On 3 July 2024, an addendum to the All Wales Weight Management Pathway (AWWMP) was published regarding the use of weight loss medications for those patients in Wales meeting the appropriate clinical criteria as described in (WHC/2024/030) published weight management medication pathway.

The addendum makes it clear that the prescribing of Glucagon-Like Peptide-1 Receptor Agonists (GLP1RAs) including semaglutide (Wegovy®) and liraglutide (Saxenda®) should take place within the confines of the appropriate level of the AWWMP (All Wales Weight Management Pathway), most likely level 3, with some appropriate use in Levels 2 and 4, in accordance with National Institute for Health and Care Excellence (NICE) guidance.

In December 2024, . NICE concluded that unlike some other weight loss medications, tirzepatide could be made available by the NHS alongside a reduced-calorie diet and increased physical activity, in both secondary and primary care settings for adults with a BMI of at least 35 kg/m2 (or a lower threshold, usually reduced by 2.5 kg/m2, for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds) and at least 1 weight-related comorbidity. .

Directions to health boards and NHS Trusts in Wales generally require a medicine approved by NICE to be made available within 2 months of publication of its final draft guidance. However, health boards and NHS Trusts are exempted from this requirement where, following NHS England submitting a funding variation request on behalf of NHS providers and integrated care boards in England, NICE extends the period within which the NHS needs to comply with its recommendations.

Given the potentially very large eligible cohort and the variation between providers in availability of infrastructure required to deliver the recommendation in full, NICE has extended the implementation period for tirzepatide for managing overweight and obesity in adults, providing up to 12 years to implement the recommendations in full.

Work is currently being undertaken to determine if and how tirzepatide and other weight loss medications licensed in the future, will be made available in the NHS in Wales. This work will consider implementation arrangements for primary care alongside the current specialist weight management services, assessment of capacity and costs, and developing safe and efficient delivery models that are scalable and sustainable.

We are aware NHS England has published interim commissioning guidance to provide a framework for commissioners in England to implement the NICE technology appraisal for tirzepatide for the management of weight during the first three years of delivery within the NHS in England. NHS England’s commissioning guidance does not apply in Wales.

Îʶ¦ÓéÀÖ Ministers will make a decision regarding any extended deployment of tirzepatide once this work is completed and we will write to NICE, local health boards and primary care contractors, outlining those arrangements in due course.

In the interim, tirzepatide, semaglutide and liraglutide, for weight loss should only be prescribed through specialist weight management services in the NHS in Wales.

There should be no new initiations of tirzepatide other than in NHS specialist weight management services.

This is not intended to affect treatment with tirzepatide started in the NHS before this circular was published. Anyone having treatment outside these recommendations may continue until they and their NHS healthcare professional consider it appropriate to stop. Anyone already receiving treatment should not be referred to specialist weight management services for continuation of prescriptions. This circular does not apply to the prescribing of tirzepatide for its other licensed indications.

We appreciate that there is considerable demand for specialist weight management services and there is a growing pressure for access to these medications through the NHS. The work currently being undertaken to determine how tirzepatide and future weight loss medications, will be made available in the NHS in Wales will ensure seamless, equitable, safe and effective access to treatment through local services delivered in accordance with a nationally agreed implementation approach.