NHS overcharged for liothyronine

According to a provisional ruling by the Competition and Markets Authority (CMA), pharmaceutical company Concordia has abused its market dominance to overcharge the NHS for the thyroid medication liothyronine.

The CMA found that the NHS spent over £34 million on liothyronine tablets last year, compared with just £600,000 in 2006. This steep rise in costs followed a debranding of the product in 2007, which increased the amount the NHS paid per pack from £4.46 to £258 by July 2017, representing a price hike of almost 6000%.

Once medicines are debranded, they are no longer governed by the Pharmaceutical Price Regulation Scheme, which allows drug companies to increase prices without restriction, and until earlier this year, Concordia was the only supplier of liothyronine.

Liothyronine is one of the treatments that NHS England and NHS Clinical Commissioners included in their consultation document on “items which should not routinely be prescribed in primary care”, because of the significant price rise and limited evidence for its efficacy above the standard therapy levothyroxine. However, they received a substantial amount of feedback from patients and organisations, including the British Thyroid Association, pointing out that some patients with hypothyroidism treated with levothyroxine continue to have symptoms despite adequate biochemical correction. Therefore, the final guidance published at the end of November allows the prescription of liothyronine on the recommendation of an endocrinologist for patients in whom levothyroxine has failed after a carefully audited trial of at least three months duration.

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