A new weight loss job is to be introduced on the NHS in England – but it could take up to 12 years for everyone to get it, the NHS drug advisory body says.
The National Institute for Health and Care Excellence (Nice) has recommended final draft guidance on monjaro to start giving it from March, along with diet and exercise advice.
It will be offered to people with a body mass index (BMI) over 35 and at least one obesity-related health problem – potentially 3.4 million people.
But due to concerns it could overwhelm services, and GPs in particular, NICE has agreed to give the NHS more than a decade to introduce it – an unprecedented move for a drug.
Professor Jonathan Banger, NICE’s chief medical officer, admitted it would mean “a lot of people will have to wait”.
But he said: “We had to make this difficult decision to protect vital NHS services and to test delivery methods for this new generation of weight-loss drugs.”
Patient groups have expressed dismay at the NHS’s decision to take so long.
Initially only patients under the supervision of a specialist weight-loss service will be offered – a similar approach to the weight-loss drug Vigovi.
But from June, the NHS will start offering it to others.
It is not clear exactly how this will be done – GP practices are likely to be in charge of referring patients, but questions remain as to who will provide ongoing support including diet and exercise and monitoring.
NHS England is expected to publish guidance on this in the New Year. This could include the use of apps or separate services set up to support GPs.
Mounjaro, or tirzepatide, made by Eli Lilly, makes you feel full so you eat less. In trials, people have lost up to a fifth of their body weight on it.
Vigovi, also known as semaglutide, which is already available on the NHS, works in a similar way. But it can only be given to people who are under the supervision of a weight loss specialist.
An estimated 40,000 people are in this position.
Drugs can be purchased privately. Both drugs are also already available for people with type 2 diabetes – although semaglutide is marketed as Ozempic for these patients.
The rollout of Mounjaro opens up the option of this new generation of weight loss drugs to a wider public who suffer from severe obesity.
To qualify, patients must also have an obesity-related condition, such as diabetes, high blood pressure or heart disease.
Under the rollout plans, priority will be given to those with the greatest medical need first.
It is estimated that around 250,000 people will benefit in the first three years.
NICE then plans to assess how it is working before proceeding with a wider rollout.
As this is final draft guidance, it is still possible that the rollout may be delayed if an appeal is made against the decision. If not, the guidance will be rubber-stamped before Christmas, NICE said.
Mounjaro, which is given by weekly injection, will cost the NHS £122 per month per patient, but NICE called it affordable given the cost of obesity.
There is a risk that users may gain weight back after discontinuing its use.
Ministers in Wales will use guidance from NICE to inform their roll-out.
It is already recommended for use in Scotland – although the NHS is reportedly struggling with its rollout.
Helen Crane of Diabetes UK said monjaro had a “significant” role in tackling obesity.
But he added: “We are concerned about how long it may take for people to gain access.”
Dr Keith McCullough, NHS England’s national specialty adviser for obesity, said weight-loss drugs were an “important tool” to tackle “one of the biggest public health problems facing the NHS”. I help.
He said the phased rollout was necessary to protect access to other NHS services that patients rely on.
And Professor Camilla Hawthorne of the Royal College of GPs warned that the drug should not be seen as a “silver bullet”, adding that it is not without risks and is not the right treatment for everyone. There will be who is eligible.