The Net Ingredient Cost (NIC) of levothyroxine and liothryonine dispensed in England in each of the last three years is provided in the following table.
NIC1 of prescription items dispensed in the community in England
British National Formulary Chemical Name
Levothyroxine Sodium and Liothyronine
Source: Prescription Cost Analysis
1NIC is based on the price listed in the Drug Tariff. It does not take into account for example any discounts and therefore the price the National Health Service paid will be different.
Both levothyroxine and liothyronine are unbranded generic medicines. For unbranded generic medicines, the Department encourages competition between suppliers to keep prices down. In primary care, community pharmacies are incentivised to source products at the lowest possible cost and in secondary care, competitive tenders ensure value-for-money to the NHS.
Liothyronine is currently the subject of an investigation by the Competition and Markets Authority, which has provisionally found that the single supplier of the product abused its dominant position to overcharge the NHS by millions of pounds for liothyronine tablets. A provisional decision does not necessarily lead to an infringement decision. Where companies have breached competition law, the Department will seek damages and invest that money back into the NHS.
Until recently, only one marketing authorisation had been granted for liothyronine. However, there are now multiple marketing authorisations for liothyronine and as a consequence of this increased competition it is expected that prices will go down.
Any medicine authorised in another European Union Member State can be imported into the United Kingdom, as long as the imported product has no therapeutic difference from the same UK product. The importer must hold a Wholesale Dealers Authorisation and a parallel import licence for the product from the Medicines and Healthcare products Regulatory Agency (MHRA). The criteria of the simplified parallel import scheme include the requirement that the UK and imported products have a ‘common origin’. In practice this usually means that they are authorised to the same company or to related companies.
Medicines unlicensed in the UK may be imported by importers holding an appropriate Wholesale Dealers Authorisation or Manufacturer’s “Specials” Licence and who notify the MHRA. Unlicensed medicines may only be imported to meet the special clinical needs of individual patients where there is no suitable licensed medicine available. Only clinical needs are admissible, not reasons of cost or other non-clinical considerations.