Ozempic on the NHS: Eligibility Criteria, Costs, and the Prescribing Pathway

NHS prescribing of Ozempic follows NICE NG 28 guidelines. These guidelines are for managing type 2 diabetes in adults. The criteria have changed to give prescribers more flexibility.

However, the main requirements remain.

Standard NICE NG 28 criteria for GLP-1 receptor agonists:

• You must have a confirmed diagnosis of type 2 diabetes mellitus.
• Your HbA1c must be above 58 mmol/mol (7.5%). This applies even after optimised first-line therapy. This means metformin must be at its maximum tolerated dose.
• You must have tried at least one other glucose-lowering drug with metformin. Or, you must have tried alternative drugs if you cannot take metformin.
• Your BMI must be 35 kg/m2 or greater. You also need specific psychological or medical problems linked to obesity. Or, your BMI can be below 35 kg/m2. In this case, insulin therapy must cause significant work problems. Or, weight loss must help other major obesity-related conditions.

Expanded prescribing considerations:

NICE now recognises the heart benefits shown in the SUSTAIN 6 study. Prescribers can consider heart risk when choosing second-line options.

This means patients with existing atherosclerotic cardiovascular disease may get a GLP-1 agonist first. This also applies to those with high cardiovascular risk. This is true regardless of their BMI.

Who does not qualify:

• Patients without type 2 diabetes do not qualify. Weight management has separate NICE guidance. This is TA 875 for Wegovy.
• Patients with type 1 diabetes do not qualify. GLP-1 agonists are not approved for this condition.
• Patients who have not explored first-line and second-line options do not qualify. This applies where these options are suitable.
• Pregnant patients or those planning pregnancy within 2 months do not qualify.

Getting an Ozempic prescription on the NHS usually follows a set pathway. This pathway may need input from a specialist.

Step 1: GP assessment and first-line treatment

Your GP will diagnose type 2 diabetes. They will then start you on metformin. You will also get advice on lifestyle changes. This includes diet, exercise, and weight management.

Your HbA1c will be checked after 3 to 6 months.

Step 2: Second-line therapy consideration

Your HbA1c may still be above 58 mmol/mol. If so, a second drug will be added. Options include sulfonylureas, SGLT2 inhibitors, DPP-4 inhibitors, pioglitazone, or GLP-1 receptor agonists.

The choice depends on your individual needs.

Step 3: GLP-1 agonist initiation

• In some areas, GPs can start GLP-1 agonists directly. They use local formulary guidance.
• In other Integrated Care Board areas, you need a referral to a diabetes specialist. This could be a consultant diabetologist or a specialist nurse.
• Some areas have virtual clinics or advice services. These allow GPs to start treatment with remote specialist support.

Step 4: Shared care and ongoing prescribing

• After the dose adjustment phase, prescribing usually returns to your GP. This phase typically lasts 8 to 12 weeks. This happens under a shared care agreement.
• Your GP provides repeat prescriptions. They also monitor your weight, HbA1c, and side effects.
• Some areas may require an annual specialist review.

Regional variation:

Prescribing rules and starting pathways differ between Integrated Care Boards. Some areas have stricter local formularies. They may prefer other GLP-1 agonists, like dulaglutide, over semaglutide.

This is based on cost or supply.

Understanding prescription charges helps you plan for your treatment costs.

Current NHS prescription charges (England, 2026):

• The standard charge is 9.90 GBP per prescription item.
• Ozempic pens count as one item per prescription. This is true for both Pen 1 (0.25/0.5 mg) and Pen 2 (1 mg).
• Needles are prescribed separately. They are also charged as one item.

Prescription prepayment certificates (PPC):

• A 3-month PPC costs about 32 GBP. It covers unlimited prescriptions.
• A 12-month PPC costs about 111 GBP.
• If you take Ozempic and other regular medicines, a PPC almost always saves you money.

Exemptions from prescription charges:

• Patients with diabetes who take medication qualify for a medical exemption certificate. This includes insulin or oral hypoglycaemics. This certificate covers all prescriptions, not just diabetes medicines.
• Apply using form FP92A. You can get this from your GP surgery.
• The exemption covers Ozempic, needles, and blood glucose testing supplies. It also covers all other medications.
• Wales, Scotland, and Northern Ireland do not charge for NHS prescriptions.

Important: diabetes exemption application

• You must apply for the exemption yourself. It is not automatic.
• Your GP or practice nurse signs the form. They confirm your diabetes diagnosis and treatment.
• The certificate is valid for 5 years. You must renew it.
• If you have a valid exemption certificate, tick the exemption box. This is on the back of each prescription form.

Most patients with type 2 diabetes on Ozempic should pay nothing for their prescriptions. This is if they have applied for and received their medical exemption certificate.

NICE NG 28 requires regular reviews of GLP-1 receptor agonist therapy. This confirms the treatment still provides benefit. It also justifies continued prescribing.

6-month review (after reaching maintenance dose):

• HbA1c: This is the main way to measure treatment response. NICE used to require an 11 mmol/mol (1.0%) reduction for continuation. Current guidance considers wider benefits.
• Body weight: Weight loss supports continued prescribing. This is true even if HbA1c targets are not fully met.
• Side effect assessment: This checks for ongoing gut issues, injection site reactions, or other worries.
• Blood glucose diary review: This happens if you monitor your own blood sugar.

Annual diabetes review (standard care):

• HbA1c: The target is usually 48 to 58 mmol/mol. This depends on your situation and risk of low blood sugar.
• Blood pressure: The target is below 140/80 mmHg. It is below 130/80 mmHg if you have kidney disease, eye disease, or cerebrovascular disease.
• Lipid profile: This checks total cholesterol, LDL, HDL, and triglycerides.
• Kidney function: This checks eGFR and urine albumin:creatinine ratio.
• Foot examination: This checks pulses, sensation, and skin health.
• Retinal screening: You will have annual digital retinal photography through the DESP.
• Cardiovascular risk assessment: This checks your heart disease risk.
• Mental health and wellbeing check: This looks at your overall mental state.
• Injection technique review: This checks how you inject. It also assesses site rotation.

Stopping criteria:

Your prescriber may consider stopping Ozempic if:

• Your HbA1c has not improved much. Also, you have not lost significant weight. This applies after 6 to 12 months at the maximum tolerated dose.
• You have side effects that you cannot tolerate. This is even after trying management strategies.
• Your clinical situation changes. For example, you plan a pregnancy or have a terminal diagnosis.
• Another treatment becomes more suitable. This could be due to new evidence or new medications.

If you are on Ozempic, you should actively use NHS diabetes services. This helps you get the most benefit from your treatment.

Structured education programmes:

• DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed): This is a group education programme. Most NHS trusts offer it for patients with type 2 diabetes.
• X-PERT Diabetes: This is another structured education programme. Some areas offer it.
• NICE NG 28 suggests all patients with type 2 diabetes get structured education. This should happen at diagnosis. Attending improves results and how well you stick to treatment.

Dietetic support:

• Ask for a referral to an NHS dietitian. This is especially important in the first 3 months of Ozempic treatment. Appetite suppression may lead to poor nutrition.
• Dietitians can help ensure you get enough protein. Aim for at least 1.2 g/kg/day. They also ensure you get enough micronutrients during weight loss.

Diabetes specialist nurse access:

• Many GP practices have diabetes specialist nurses. They can train you on injection technique. They also offer dose adjustment advice and ongoing support.
• Some areas offer phone or virtual clinic follow-ups. These happen between face-to-face appointments.

NHS app and digital services:

• Order repeat prescriptions through the NHS App.
• View your test results online. This includes HbA1c, blood pressure, and cholesterol.
• Book GP appointments for diabetes reviews.

Self-management essentials:

• Keep a record of your weight each week. Note any side effects to discuss at reviews.
• Carry your diabetes identification. This could be your medical exemption certificate or a Diabetes UK ID card.
• Know the signs of low blood sugar. The risk is low with Ozempic plus metformin, but it is still good to know.
• Attend all screening appointments as planned. This includes retinal, foot, and kidney screenings.

Patients often have concerns about getting Ozempic on the NHS. Addressing these directly helps you understand the system.

"My GP refused to prescribe Ozempic. What can I do?"

GPs prescribe based on local guidelines and NICE criteria. If you think you meet the criteria, ask your GP why they refused. You can ask for a referral to a diabetes specialist for a second opinion.

You can also see a different GP at the same practice.

"I have been switched from Ozempic to another drug because of supply issues."

This is a known problem. Your prescriber should record that the switch was due to supply. It should not be for clinical reasons. They should plan to switch you back when supplies return to normal.

If Ozempic controlled your condition well, ask for a review within 3 months. This will assess the alternative drug.

"Can I get Ozempic for weight loss through the NHS?"

No, not Ozempic specifically. If you meet the criteria for obesity treatment, ask your GP for a referral. This is for a specialist weight management service. You need a BMI of 30 or higher.

Or, a BMI of 27 or higher with other health conditions. Wegovy (semaglutide 2.4 mg) is available through these services. This is under NICE TA 875.

"The waiting list for the diabetes specialist clinic is months long."

Ask your GP if advice services or virtual specialist reviews are available locally. Some areas offer pharmacist-led GLP-1 initiation clinics. These reduce specialist waiting times.

"I started Ozempic privately. Can my GP continue prescribing on the NHS?"

This depends on local shared care agreements. Some GPs will take over prescribing if you meet NHS criteria. Others may refuse.

Discuss this with your GP before assuming the NHS will continue a private prescription.