Draft guidance from a UK health regulatory body released Tuesday could allow more patients on the NHS to access Eli Lilly’s weight-loss drug tirzepatide than Novo Nordisk’s GLP-1 competitor semaglutide. The broader coverage recommendation comes as Lilly has earmarked $9 billion to boost production capacity of tirzepatide at its manufacturing site in Lebanon, Indiana. Tirzepatide, a dual GLP-1/GIP agonist, is marketed as Mounjaro for both weight loss and type 2 diabetes in the UK.Semaglutide, approved as Wegovy for obesity, has been covered by the NHS since September, but is required to be used “within a specialist weight management service providing multidisciplinary management of overweight or obesity.” Not only is access to such services unequal – and sometimes limited – across the country, patients are only able to use the services for two years, thereby also capping the continued use of Wegovy at two years.However, the UK’s National Institute for Health and Care Excellence (NICE) recommended that tirzepatide not be restricted with a specialist weight management service requirement, therefore not limiting the number of years a patient can take the weight-loss drug, and potentially also allowing patients who previously couldn't access weight management services – and thus Wegovy – to receive Lilly’s treatment. The lack of a time limit on Mounjaro may make the drug more favourable among patients, especially as users have been shown to regain weight once treatment is stopped.Cost-effective restrictionsBroadly, NICE has recommended that Mounjaro be used in patients with an initial body mass index (BMI) of at least 35 kg/m2 and at least one weight-related comorbidity.While the US pharma originally sought coverage in people with a BMI of at least 30 kg/m2 – the population that Mounjaro is approved to treat – the organisation said that use of the drug in that patient group would exceed the acceptable incremental cost-effectiveness ratio (ICER) of £20,000 ($25,540) per quality-adjusted life year (QALY). However, Lilly and NICE’s ICER estimates for Mounjaro in the 35 kg/m2 BMI group ranged between £15,355 to £19,535 per QALY, coming in under the acceptable threshold. The list price of a 4-week supply of Mounjaro in the UK is currently between £92 and £122, depending on the dosage. Wegovy is available in the UK to certain patients with a BMI of 30 kg/m2 to 34.9 kg/m2, but they must meet specific referral criteria. Four doses of Novo Nordisk’s drug costs between £73.25 and £175.80.Comments are due on NICE’s draft guidance for Mounjaro by June 25, and the final recommendation is expected by the end of October.