FOI 2025/1519

Reporter for The Pharmacist.
I am writing to you under the Freedom of Information Act 2000 to request the following information regarding tirzepatide (Mounjaro) use in your ICB area:
1. Please provide the total cost to the ICB of tirzepatide (Mounjaro) since it became available across specialist weight management services and primary care settings on 23 June 2025. If possible, please break this down by month.
2. How many patients have been prescribed tirzepatide since the 23 June 2025? Please can you provide an overall total and monthly totals if possible (e.g., 23 June–23 July, 23 July–23 August, etc.).
3. Does your ICB have any thresholds for treatment that differ from the national thresholds – if so, what are your local thresholds?
4. How many patients who met the national eligibility threshold for tirzepatide have been declined treatment by the ICB or by services commissioned by the ICB?
5. How many patients are currently on a waiting list for tirzepatide treatment?
If it is not possible to provide the information requested due to the information exceeding the cost of compliance limits identified in Section 12, please provide advice and assistance, under the Section 16 obligations of the Act, as to how I can refine my request.
If you can identify any ways that my request could be refined, I would be grateful for any further advice and assistance.

1. Prescribing expenditure data for tirzepatide can be accessed via publicly available sources such as OpenPrescribing (https://openprescribing.net)

However, it is important to note that:

• NHS prescribing datasets do not reliably distinguish between tirzepatide prescribed for type 2 diabetes and tirzepatide prescribed for weight management, and
• As a result, any total cost figures obtained from these datasets would reflect combined use across indications, not weight management alone.

2. For the four-month period of June 2025 to September 2025, 8,605 patients have been prescribed Mounjaro (tirzepatide) within Greater Manchester ICB.

   The number of patients that have been prescribed tirzepatide (Mounjaro) within Greater Manchester ICB within each individual month are set out below:

June 2025:       5,863
July 2025:         6,442
Aug 2025:        5,722
Sep 2025:        7,071

Please note the following important limitations:

• The prescribing data available to the ICB does not distinguish between indications. As such, the figures include prescribing for both type 2 diabetes and weight management and cannot be reliably separated by indication.
• Monthly totals can only be provided by calendar month, as the dataset records the dispensing month only. It is therefore not possible to provide figures covering bespoke date ranges (e.g. 23 June–23 July).

3. NHS Greater Manchester does not apply thresholds that differ from national eligibility criteria.

Local commissioning arrangements are set out in the GM Tirzepatide for weight management in adults- interim commissioning statement (version 1.2), which is publicly available on the GMMMG website (https://gmmmg.nhs.uk/wp-content/uploads/2025/09/Tirzepatide-for-weight-management-in-adults-commissioning-statement-for-GM-V1.2-for-GMMMG-website.pdf ) This statement confirms adoption of NHS England national eligibility criteria for tirzepatide in specialist weight management services and in primary care.

In addition, NHS Greater Manchester has applied local prioritisation within Cohort 1, dividing this cohort into three sub-cohorts (1a, 1b and 1c) to prioritise patients with the highest clinical needs and to support financial sustainability.

As part of the phased implementation, Sub-cohort 1a is currently being enrolled within NHS Greater Manchester.

4. The ICB follows the NHS England interim commissioning guidance for tirzepatide implementation, as confirmed in the GM commissioning statement and the treatment is offered to patients who meet the criteria set out in the commissioning statement.

As part of the current phase of implementation, all patients who meet the criteria for Sub-cohort 1a are being invited for consideration of prescribing of tirzepatide. In this context, patients are not declined treatment by the ICB where they meet the applicable national and locally implemented criteria.

Decisions not to proceed with prescribing may occur if it is clinically inappropriate. Such decisions are clinical in nature, rather than commissioning or eligibility decisions.

5. The ICB does not maintain a single, GM-wide waiting list for tirzepatide treatment.

In Greater Manchester, tirzepatide is being offered in two settings:

• Primary care, where the majority of treatment is being delivered, and
• Specialist Weight Management Services (SWMS).

In primary care, there is no specific waiting list for tirzepatide treatment. Prescribing is offered in line with the commissioning arrangements and local prioritisation within the phased implementation.

In Specialist Weight Management Services, referrals are limited to more complex patients who require additional multidisciplinary support during treatment (for example, psychological support). Waiting lists within SWMS are managed locally by individual providers and are primarily for access to SWMS, rather than for a specific medicine. The ICB does not hold information that reliably distinguishes patients waiting specifically for tirzepatide treatment within SWMS.

As such, the ICB does not hold a definitive figure for the number of patients currently “on a waiting list” for tirzepatide treatment across Greater Manchester.