Tirzepatide in the UK: how NICE TA924 and TA1026 shape access

The MHRA authorises tirzepatide in the UK under the brand Mounjaro for both type-2 diabetes and weight management. NHS access, however, runs through the National Institute for Health and Care Excellence (NICE), and NICE issued two separate technology appraisals on two separate dates with two separate sets of criteria. If you are reading about "NICE on Mounjaro," you are reading about one or the other.

TA924: tirzepatide for type-2 diabetes (October 2023)

NICE TA924 covers tirzepatide as a treatment option for type-2 diabetes when triple therapy with metformin and two other oral antidiabetic drugs has failed to achieve adequate glycaemic control, and when insulin therapy has clinical concerns or is unacceptable. The trial evidence cited is primarily SURPASS-2 (the head-to-head against semaglutide 1 mg) and the broader SURPASS programme.

Patients prescribed under TA924 typically have an HbA1c at or above 58 mmol/mol (7.5%) and have tried at least two other classes. Once on tirzepatide, the NHS prescribes for as long as glycaemic targets are met.

TA1026: tirzepatide for managing obesity (December 2024)

NICE TA1026 is the obesity-management technology appraisal. It recommends tirzepatide as an option for managing overweight and obesity within specialist weight-management services, alongside a reduced-calorie diet and increased physical activity. The eligibility criteria are tighter than the marketing authorisation: BMI of 35 or above plus at least one weight-related comorbidity, or BMI between 30 and 34.9 with comorbidities meeting specific severity definitions.

TA1026 also imposes service-delivery constraints. It is phased into specialist NHS weight-management services rather than open prescribing, and access depends on local service capacity. Some integrated care boards have introduced waiting lists.

The split matters for patients

A patient with type-2 diabetes and obesity can be eligible under TA924 but not under TA1026 if their BMI and comorbidities do not meet the obesity-management criteria. The opposite also holds. The two routes do not transfer, and the clinical setting (diabetes clinic vs weight-management service) differs.

Private prescription is an alternative for patients outside the NHS criteria. Private pricing varies by pharmacy and dose, typically in the £180 to £400 per month range depending on the strength and supplier.

What is NOT covered by TA924 or TA1026

Obstructive sleep apnea. The Zepbound OSA approval (FDA, December 2024) is a US indication; it has not been the subject of a NICE technology appraisal in the UK. Off-label OSA prescribing on the NHS would sit outside both TAs.

For the cross-country picture, see tirzepatide regulation by country and the UK regulation hub.