From 1 September, the list price for the most popular and effective weight loss injection (Mounjaro) in the UK will rise by almost three times, from £122 to £330 a month for the highest dose.
This is a huge increase, which for many people will take the drug from affordable to not affordable in one fell swoop. It will impact an estimated 1.5 million people currently paying out of their own pocket for this drug in the UK - and we will likely see thousands of people coming off it as a result.
But it’s not just individuals, the NHS also pays for Mounjaro, and it comprises a key part of the government’s plan to tackle ever increasing obesity rates.
While the drug’s manufacturer, Eli Lilly, has confirmed the overall cost of the drug will remain unchanged to the NHS for now, it is clear the NHS can no longer rely on the private market to pick up the slack. If the government is serious about tackling obesity and driving the prevention agenda, the NHS will need to move far quicker on rolling these anti-obesity medications out at scale.
Obesity is one of the biggest drivers of poor health, placing an immense strain on our health and welfare systems, and a drag on the UK economy. It is also increasingly a key driver of health inequalities, with current access to anti-obesity medications (AOM) largely based on ability to pay rather than need. The NHS recognises there’s a problem and plans to make Mounjaro available to 220,000 more people within three years, rising to 3.4 million over the next twelve years.
But these timescales are too slow. Obesity rates are projected to rise far faster than this programme can deliver.
Obesity rates are projected to rise far faster than this programme can deliver.
Part of the challenge lies in the proposed care model. It is highly resource intensive: in the first year alone, a single patient initiated on Mounjaro could require over 30 separate appointments costing more than £1,200. By contrast, private providers have shown that access can be streamlined through digital-first models, allowing patients to get prescriptions online and medicines via home delivery.
The NHS could achieve significant savings – and faster rollout – by adopting a similar approach through the NHS App. Especially if they introduce outcomes-based contracts – only paying when people lose weight.
Another issue is price but the NHS has a unique advantage, the likes of which no private provider can match – purchasing power. The NHS uses this regularly - and has already done deals with drug manufacturers on GLP-1 medications - but to ensure faster, broader access, will the government consider other more controversial policies? Will they countenance means testing for instance? Or sharing the cost with employers? Or decommissioning other health services?
If money’s tight but prevention is a priority, what are we willing to forego?
Anti-obesity medicines are not a silver bullet, but they can shift the dial on the obesity crisis, especially if combined with broader public health measures. What the UK cannot afford is complacency. A slow NHS rollout will cost the UK more in lost productivity and increased health and welfare spending as well as risking entrenched inequality where those who can afford to buy treatments privately, while others wait years for access or turn to unsafe versions online.
The September price hike is a warning shot. It shows what happens when private demand surges ahead of public provision. The NHS must not sleepwalk into a two-tier system. It has the tools and the bargaining power to act. The future of obesity treatment should be determined by need, not means. And only the NHS can make that happen.
Dr Charlotte Refsum is Director of Health at the Tony Blair Institute
