In NHS South West London, prescribing of Semaglutide (Wegovy®) for weight loss is restricted to tier 3 and 4 weight management services, in line with the criteria set and therefore should not be issued in primary care.
On 8 March 2023, the National Institute for Health and Care Excellence (NICE) published guidance recommendations [TA875] on semaglutide for managing overweight and obesity within specialist weight management services (including Tier 3 and 4), in line with specific criteria.
At the time of the NICE publication, Wegovy®, was not commercially available for NHS use in the UK. From September 2023, Novo Nordisk, the manufacturer of Wegovy® confirmed supplies would be made available to the NHS a controlled and limited launch.
SWL ICB in conjunction with our locally commissioned weight loss specialist service has now refreshed the existing weight management pathways and referral guidelines to incorporate Wegovy® alongside the prescribing of Liraglutide (Saxenda®).
The prescribing of both Wegovy® and Saxenda® are restricted to SWL commissioned tier 3 and 4 weight management services in line with NICE TA875 and TA664 respectively.
Prescriptions of all liraglutide or semaglutide-containing formulations for the management of weight should not be issued in primary care.
Clinicians can access the local tier 3 and 4 weight management referral form and pathway for Wegovy® and liraglutide via DXS.
Update on Oviva Specialist Tier 3 Weight Management services
We are aware that many practices have been contacted by Oviva to refer patients to their remote NHS Tier 3 Weight Management programme, that includes supply of GLP-1 medications. Currently they are only offering Wegovy.
SWL ICB currently does not commission Oviva’s Tier 3 weight management services, however as the provider holds a qualifying NHS standard contract in England, it has been made available as an option on the electronic referral system (eRS) as national service offering under patients right to choice.
NHS England’s choice team are looking into this service offering and the ICB will provide further communication once further assurances regarding this provider has been clarified.
NICE are due to publish guidance on use of tirzepatide for managing overweight and obesity’ in December 2024. They are currently consulting on a funding variation that will extend the implementation period for this guidance from the usual 90-days. The funding variation includes an additional 90 days before any requirement on ICBs to fund the medicine, providing a 180-day implementation period. Following the 180 days, a period of three years where eligibility will increase in stages has been proposed. Following this, up to a maximum of a further nine years, (12 years in total) could be built into the phasing dependent upon maturation of the local obesity treatment pathway in primary care.
Rationale
Following publication of the guidance, NHS South West London will need to review existing weight management services and pathways to incorporate the recommendations. In the interim, there should be no prescribing of tirzepatide in primary or secondary care for weight management.
Recommendations
Tirzepatide is non formulary and not recommended for the indication of weight loss and obesity across all settings. The formulary status will be reviewed once NICE publishes guidance use for this indication.
Guidance for clinicians
- Prescribing of tirzepatide off-label solely for weight loss (in the absence of a type 2 diabetes diagnosis) is not supported.
- Tirzepatide (Mounjaro®) must only be prescribed for the treatment type 2 diabetes in adults and outlined in its monograph entry in the SWL Joint Medicines Formulary.
- At this point in time, it is inappropriate to request prescribing of or prescribe tirzepatide to manage weight where patient’s HbA1c is adequately controlled with oral triple therapy (excluding oral semaglutide).
Guidance for patients, carers, and guardians
- Patients who have been self-funding tirzepatide or other weight loss medications, prior to the publication of NICE guidance, who meet the eligibility criteria, may need to continue funding their treatment, until SWL weight management pathways are updated.
- Please do not contact your GP practice with a request to prescribe.
- The NHS belongs to you, use it responsibly.
References
NICE TA in development Tirzepatide for managing overweight and obesity [ID6179]