Obesity medicines (OMs), including GLP-1 receptor agonists such as semaglutide (Wegovy®) and tirzepatide (Mounjaro®), have significantly expanded treatment options for people living with overweight and obesity. While evolving clinical guidance increasingly emphasises anthropometric measures beyond BMI alone, UK reimbursement criteria remain anchored to historical eligibility thresholds. In practice, publicly reimbursed access through the NHS is constrained by sequential gating mechanisms, phased roll-out, and stopping rules. Meanwhile, a growing private market provides an alternative route for eligible patients willing to self-fund, contributing to a widening divergence between public and private access pathways.
Authors: Hill, L; Robson, A; Humphries, AC; Miller G
Objectives:
This study aimed to: (1) compare UK public and private access pathways for OMs; (2) identify structural gaps in publicly reimbursed access; (3) explore how varying patient needs and preferences map to public and private treatment pathways; and (4) consider implications for manufacturers in high-demand disease areas characterised by consumer-influenced dynamics.
Methods:
A qualitative, framework-based analysis was conducted using publicly available sources to map access pathways and identify key structural constraints. Sequential gating in public reimbursement was examined relative to the full in-label population. A hypothesis-led segmentation framework was developed to explore how initiation drivers (e.g., medical risk reduction, functional improvement, or patient-defined goals) may map differently to NHS versus private routes. A second hypothesis-led framework examined how access context may influence treatment journey behaviours, including expectations, monitoring, persistence, and cycling.
Results:
Public access is materially narrower than the full in-label population due to eligibility thresholds, referral requirements, phased implementation, and response-based continuation rules. Patients close to eligibility boundaries or prioritising timely initiation may face delays or exclusion within NHS pathways. In contrast, private access accommodates a broader segment, including individuals below NHS BMI thresholds or without qualifying comorbidities.
Initiation drivers differ by route: public pathways are predominantly clinical-risk-led, whereas private routes are more strongly influenced by patient-defined goals, urgency, and convenience. These differing entry contexts may shape downstream behaviour. Public access is embedded within structured, programme-based care with defined monitoring and stopping criteria. Private access, by contrast, may involve variable follow-up intensity and greater sensitivity to cost and perceived benefit, potentially increasing the likelihood of discontinuation and re-initiation (“cycling”).
Conclusions:
OMs illustrate how private pathways can emerge as parallel access channels when public systems constrain eligibility and capacity. While private uptake may broaden early treatment initiation and generate strong demand signals, it also introduces equity concerns and greater variability in care delivery. For manufacturers, private markets represent both opportunity and risk: early consumer-driven uptake may strengthen commercial momentum but can heighten payer scrutiny regarding population definition, durability of outcomes, and affordability controls. Understanding how access route shapes patient behaviour will be increasingly important in therapeutic areas characterised by high demand and constrained public reimbursement.
Access the full research HERE
