What NICE technology appraisals are and how to read TA875 and TA1026

Two NICE documents are quoted in almost every news story about NHS access to Wegovy and Mounjaro: technology appraisal 875 for semaglutide and technology appraisal 1026 for tirzepatide. They are short, public and written in plain English, and they are often read as if they said more than they do. This article explains what a technology appraisal is and how to read these two. The NHS access article on this site covers what the recommendations mean in a GP appointment.

What a technology appraisal is

The National Institute for Health and Care Excellence (NICE) describes the format in one sentence: "Technology appraisal (TA) guidance makes recommendations on the use of new and existing medicines and other treatments within the NHS." The weight of a TA comes from the duty attached to it: "The NHS is legally obliged to fund and resource medicines and other treatments recommended by our TAs." NICE also says it works closely with the MHRA "to make sure we can publish our guidance in a timely way", so that guidance can follow a licence.

A TA asks whether a medicine's benefit justifies its cost to the NHS for a defined group of people, and its recommendations describe that group. It is not the licence. The licence, which says what the medicine may be used for at all, comes from the MHRA and is written into the SmPC and the leaflet. A TA can recommend a medicine for a narrower group than the licence covers, and both of these do.

Every appraisal page has the same parts: an overview with the publication and update dates and the commercial arrangement; section 1, the recommendations; section 2, information about the medicine, including its list price to the NHS; section 3, the committee's discussion of the evidence; section 4, implementation; and a tab called "Information for the public". The recommendations are the operative part. The committee discussion is where the reasoning sits, including why a group was or was not recommended.

TA875: semaglutide

TA875 was published on 8 March 2023 and updated in September 2023. It recommends semaglutide (Wegovy) "as an option for weight management, including weight loss and weight maintenance, alongside a reduced-calorie diet and increased physical activity in adults, only if" a set of conditions is met. The conditions are: use "for a maximum of 2 years, and within a specialist weight management service providing multidisciplinary management of overweight or obesity"; at least one weight-related comorbidity; and a body mass index of at least 35.0 kg/m², or of 30.0 to 34.9 kg/m² together with the criteria for referral to a specialist service in NICE's obesity guideline. Lower BMI thresholds, usually reduced by 2.5 kg/m², apply to people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family backgrounds. The company must also provide the medicine under its commercial arrangement with the NHS.

TA1026: tirzepatide

TA1026 was published on 23 December 2024 and updated on 1 September 2025. It recommends tirzepatide (Mounjaro) "as an option for managing overweight and obesity, alongside a reduced-calorie diet and increased physical activity in adults, only if they have" an initial BMI of at least 35 kg/m², at least one weight-related comorbidity, and the company provides it under the commercial arrangement. The same lower BMI threshold applies for the ethnic backgrounds listed above. There is no two year limit and no requirement to be in a specialist service; the committee notes that tirzepatide "can be used in primary care or specialist weight management services".

The appraisal also records what NICE did not recommend. The company proposed use for adults with a BMI of at least 30 kg/m² and one comorbidity, and the committee found the cost effectiveness estimates for that group "above the range that NICE considers an acceptable use of NHS resources". That sentence is about cost to the NHS for that group, and nothing else.

TA1026 carries a funding variation. NICE's "What this means in practice" section says tirzepatide "must be funded in the NHS in England to manage overweight and obesity in adults, if it is considered the most suitable treatment option", and that "it will be introduced in phases". NHS England's interim commissioning guidance sets out who may be eligible over the three years from publication, by BMI and by the number of listed weight-related conditions: high blood pressure, dyslipidaemia, obstructive sleep apnoea, cardiovascular disease and type 2 diabetes. The first phase covered people with a BMI of 40 kg/m² or more and four or more of those conditions, with later phases widening the group. NICE's page gives the schedule.

What the appraisals do not say

• They say nothing about private prescribing. A TA is a decision about NHS funding. It does not set the conditions for a private prescription, so the eligibility rules in news reports do not describe who can be prescribed the medicine privately.
• They are not a league table. The recommendations in each appraisal are about one medicine for a defined NHS group. This site ranks no medicine against another, and the appraisals are not a reason to.
• They are not dosing guidance. Each appraisal contains a recommendation to NHS clinicians about reviewing treatment after six months. The words to read are NICE's own, on the pages linked below.
• They do not override the clinician. NICE's note at the top of each appraisal says its recommendations "do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian".

Sources

• NICE, Semaglutide for managing overweight and obesity, technology appraisal guidance TA875: nice.org.uk/guidance/ta875
• NICE, Tirzepatide for managing overweight and obesity, technology appraisal guidance TA1026: nice.org.uk/guidance/ta1026
• NICE, About technology appraisal guidance: nice.org.uk
• The Dose Club, NHS access to Wegovy and Mounjaro: what NICE recommends (article on this site)

This article is information, not medical advice. Talk to your prescriber about your treatment.