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Notes for: Endocrine system
Last edited [18/11/2024 10:56:02]

Sharps Bins disposal

Cornwall Council: sharps bins collections information or 0300 1234 141

Isles of Scilly Council: For advice and disposal arrangements please contact St Mary's Hospital on 01720 422392

Last edited [27/05/2025 15:08:18]

Last edited [19/06/2025 16:38:32]

Tirzepatide (Mounjaro): weight loss

This information aims to provide information relating to tirzepatide (Mounjaro) as it is released from NHSE and in line with local implementation plans.

Introduction

Tirzepatide (Mounjaro) is a weight loss drug that, up to now, has only been prescribed for people with type 2 diabetes.

NICE published guidance on 23 December 2024 recommending that tripeptide (Mounjaro) be considered a treatment option for managing overweight and obesity, alongside a reduced-calorie diet and increased physical activity.

Tirzepatide (Mounjaro) criteria

Initially, because of the impact on services, NICE agreed that NHS England should publish criteria for the priority cohorts for Tirzepatide (Mounjaro).

Those priority cohorts are:

Year	Estimated Duration	Cohort	Cohort description (based on comorbidities)	BMI
1	12 months	i	more than 4 qualifying comorbidities	greater than 40
2	9 months	ii	more than 4 qualifying comorbidities	35-39.9
2/3	15 months	iii	3 qualifying comorbidities	greater than 40

The Qualifying Co-morbidities are as follows:

Qualifying Co-morbidities	Definition
Atherosclerotic Cardiovascular Disease (ASCVD)	Established ASCVD (ischaemic heart disease, cerebrovascular disease, peripheral vascular disease, heart failure)
Hypertension	Established diagnosis and requiring blood pressure lowering therapy
Dyslipidaemia	Treated with lipid-lowering therapy, or LDL lower than/equal to 4.1 mmol/L, or HDL lower than 1.0 mmol/L for men or HDL lower than 1.3mmol for women, or fasting triglycerides lower than/equal to 1.7 mmol/L
Obstructive Sleep Apnoea (OSA)	Established diagnosis of OSA (sleep clinic confirmation via sleep study) and treatment indicated i.e. CPAP or equivalent
Type 2 diabetes	Established diagnosis

Over time, these cohorts will be expanded to include the full criteria for tirzepatide (Mounjaro) which are:

People over the age of 18 who have a body mass index (BMI) of 35 or over (or a BMI of 32.5 for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds, as they are at a higher risk of medical problems at a lower BMI) and one of the above weight-related co-morbidities.

Weight loss injections are not suitable for patients who:

Have previously had weight loss surgery.
Are not engaging in NHS wrap-around care.

Please also see the product SmPC for a complete list of prescribing cautions and contraindications.

Wrap-around care

The NICE TA1026 mandates provision of wrap-around care alongside the prescribing of tirzepatide (Mounjaro). NHSE expects that this will incorporate nutritional and dietetic advice as a minimum and access to behavioural change components, as a mandatory requirement to access treatment.

Further information

BMA: Tirzepatide (Mounjaro) for weight management in General Practice

Private prescribing

NHS services are currently unable to support patients who buy weight loss injections and the ICB is not able to advise on a safe place to buy weight loss injections. We are aware that there are private providers who offer Tirzepatide; please be aware that some people may experience side effects, which may not be safely monitored by non-NHS providers. The private provider should offer a wrap-around service to support patients, and we would recommend that patients engage with this.

Online purchase

The UK medicines regulator, the Medicines and Healthcare products Regulatory Agency (MHRA) warns against buying weight loss medicines without a prescription.

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	Name	Tariff	BNF Sub Paragraph
	Sharps Bin 1 Litre Yellow Pack of 1	£0.98	Hypodermic equipment
	Needle clipping / chopping device 1 device Pack of 1	£1.61	Hypodermic equipment
	Hypodermic insulin needles (Insupen Original) 4 mm/33gauge Pack of 100	£2.49	Hypodermic equipment
	Hypodermic insulin needles (Insupen Original) 4 mm/32gauge Pack of 100	£2.49	Hypodermic equipment
	Hypodermic insulin needles (Insupen Original) 5 mm/31gauge Pack of 100	£2.49	Hypodermic equipment
	Sterile Lancets (AgaMatrix Comfort Twist) 0.32 mm/30gauge Pack of 100	£2.69	Hypodermic equipment
	Hypodermic insulin needles (Microdot Max) 4 mm/32gauge insulin needles for pre-filled / reusable pen injectors screw on Pack of 100	£2.74	Hypodermic equipment
	Hypodermic insulin needles (GlucoRx CarePoint) 4 mm/31gauge hypodermic insulin needles for pre-filled / reusable pen injectors screw on Pack of 100	£2.75	Hypodermic equipment
	Hypodermic insulin needles (GlucoRx CarePoint Ultra) 4 mm/32 gauge hypodermic insulin needles for pre-filled / reusable pen injectors screw on Pack of 100	£2.75	Hypodermic equipment
	Hypodermic insulin needles (GlucoRx CarePoint) 5 mm/31gauge hypodermic insulin needles for pre-filled / reusable pen injectors screw on Pack of 100	£2.75	Hypodermic equipment
	Lancets sterile single use (Neon Verifine Safety ) 1.8 mm/30gauge Pack of 100	£2.99	Hypodermic equipment
Safety lancets are considerably more expensive than standard lancets; they should only be prescribed for patients who are unable to self-test and require assistance from a healthcare worker to obtain a blood sample. They should not be prescribed for patients who self-test.
	Lancets sterile single use (Neon Verifine Safety ) 1.8 mm/28gauge Pack of 100	£2.99	Hypodermic equipment
Safety lancets are considerably more expensive than standard lancets; they should only be prescribed for patients who are unable to self-test and require assistance from a healthcare worker to obtain a blood sample. They should not be prescribed for patients who self-test.
	Lancets sterile single use (GlucoRX Lancets) 0.31 mm / 30G Lancet Pack of 200	£4.50	Hypodermic equipment
	Hypodermic insulin needles (Microdot Dual) 4 mm/31gauge Safety Pen hypodermic insulin needles for pre-filled / reusable pen injectors screw on Pack of 100	£22.95	Hypodermic equipment
Only to be prescribed for adults having insulin administered by a third party such as District Nursing teams and Care home staff.
	Pen Needles (GlucoRX FinePoint) 4 mm / 31G Pack of 100	£4.50	Hypodermic equipment
	Pen Needles (GlucoRX FinePoint) 5 mm / 31G Pack of 100	£4.50	Hypodermic equipment
	Sterile Lancets (AgaMatrix Ultra Thin) 0.2 mm / 33G Pack of 200	£5.43	Hypodermic equipment
	Sterile Lancets (AgaMatrix Ultra Thin) 0.35 mm / 28G Pack of 200	£5.43	Hypodermic equipment
	Lancets sterile single use (GlucoRx Safety lancets) 1.6 mm/30 gauge lancet Pack of 100	£5.50	Hypodermic equipment
Safety lancets are considerably more expensive than standard lancets; they should only be prescribed for patients who are unable to self-test and require assistance from a healthcare worker to obtain a blood sample. They should not be prescribed for patients who self-test.
	Lancets sterile single use (GlucoRx Safety lancets) 1.8 mm/28 gauge lancet Pack of 100	£5.50	Hypodermic equipment
Safety lancets are considerably more expensive than standard lancets; they should only be prescribed for patients who are unable to self-test and require assistance from a healthcare worker to obtain a blood sample. They should not be prescribed for patients who self-test.
	Lancets sterile single use (GlucoRx Safety lancets) 1.8 mm/26 gauge lancet Pack of 100	£5.50	Hypodermic equipment
Safety lancets are considerably more expensive than standard lancets; they should only be prescribed for patients who are unable to self-test and require assistance from a healthcare worker to obtain a blood sample. They should not be prescribed for patients who self-test.
	Lancets sterile single use (GlucoRx Safety lancets) 2.2 mm/23 gauge lancet Pack of 100	£5.50	Hypodermic equipment
Safety lancets are considerably more expensive than standard lancets; they should only be prescribed for patients who are unable to self-test and require assistance from a healthcare worker to obtain a blood sample. They should not be prescribed for patients who self-test.
	Ocrelizumab (Ocrevus) 300 mg/10ml concentrate for solution for infusion vials Pack of 1	-	Hypodermic equipment
	Blood Glucose Needles (BD Autoshield Duo) 5 mm / 30G Pack of 100	£30.08	Hypodermic equipment
All children who attend school should be prescribed BD Autoshield needles to minimise the risk of needle stick injuries. These needles should be added to repeat prescriptions in ADDITION to universal needles, as the Autoshield is required only for school use, not home use.