I wanted to say a few things about pharmacies ordering specific brands of levothyroxine for patients.
1. Independent pharmacies should usually be able to order a particular manufacturers product, assuming that it is in stock. The 4 largest wholesalers in the UK: Phoenix, Alliance, AAH and Mawdsleys all offer pharmacies a choice of product when ordering. Other wholesalers simply sell 'levothyroxine' but the manufacturer may vary, except for OTC Direct who always sell the Almus brand for 50mcg and 100mcg. OTC is a wholesaler of generics to independent pharmacy.
2. Pharmacy chains may have ordering restricted by Head Office, but some are more flexible than others. It is usually possible to order a specific product by telephoning the wholesaler, even if computerised ordering is blocked.
3. Due to the small number of manufacturers, it is easy to obtain a specific product, although the packing may vary. Avoid having prescribing written as Eltroxin, due to supply issues the pharmacy may not be able to dispense any medication. Instead, simply have prescriptions written as levothyroxine and find a helpful pharmacy.
4. TEVA as currently distributing AMCo/Mercury's 50mcg and 100mcg tablets, instead of their own. In order to obtain the AMCo/Mercury product, pharmacies can order TEVA from their wholesaler (if the AMCo/Mercury product is not listed separately on the system). Major wholesalers always list TEVA and Actavis separate on the system, because these companies offer specific buying schemes to pharmacies. These products can therefore be ordered by name. The AMCo/Mercury product is not always listed by name, but is generally supplied when ordering the wholesaler's own line. For example, Phoenix list levothyroxine 100mcg as follows:
Levothyroxine 100mg tabs ACTAVIS (28)
Levothyroxine 100mcg tabs ACTAVIS (1000)
Levothyroxine 100mcg tabs TEVA (28) - Mercury will be supplied at present.
Levothyroxine 100mcg tabs PHD/Phoenix (28)
If ordering Phoenix's own PHD line, AMCo is likely to be supplied but this is not set in stone.
5. Lloyds and Almus are not manufacturers, but simply have Actavis supply levothyroxine in special packaging for them. Lloyds branded packs are only supplied via AAH pharmaceuticals to Lloyds pharmacies. Almus branded packs are supplied via Alliance Heathcare to Boots and independents, and by OTC Direct and occasionally other wholesalers to independents.
6. The price of different brands varies by up to about 60p per pack of 28. Although not available at the moment, Eltroxin is not very different in price to the unbranded packs. Because there are few manufacturers and hence minimal price competition, and due to the expectation that generics will be sold for less than Eltroxin, the existence of Eltroxin is probably partly responsible for the low cost of levothyroxine in the UK - it effectively provides a maximum price for the generics. In the absence of the Eltroxin brand, the generics may tend to increase in price.