Amdipharm Speaks re Eltroxin/levothyroxine

[helvella]

At last. Although is is dated 10 April 2014, I have only just found this document published by Amdipharam about the differences between Eltroxin and their generic levothyroxine - and how these differences will be disappearing.

Levothyroxine and Eltroxin tablets from Amdipharm Mercury (formerly Mercury Pharma) (“AMCo”)

We understand that there is confusion for some patients about which products are available, and whether products marketed by AMCo as branded Eltroxin or as generic levothyroxine are the same or different.

This communication is provided to try and help to clear any confusion.

amcolimited.com/media/21282...

Rod

[Daffers123]

Well done for finding that. I am so pleased to have a confirmation and will take it along to show my endo and GP - perhaps that will convince them we're not all basket cases!

[Pink_Bear]

Thanks very much for tracking down and posting this. I'm afraid I am still somewhat sceptical that this very small amount of powdered acacia was sufficient to make me feel so ill. Perhaps it was this combined with their "manufacturing difficulties" - I suppose we'll never know. I'm not confident enough to go back to it yet, but will watch here with interest to see what is said about it over the next few months.

[helvella in reply to Pink_Bear]

If MP had continued to produce Eltroxin as well as levothyroxine, it is possible that patients would have noticed a change in that as well. Say the source of any of the ingredients changed? Their lab testing might not have shown any difference (so according to MP, there was no intentional change, indeed no real change at all) but patients might have noticed.

Rod

[fran5-tess in reply to Pink_Bear]

Just found this post, and totally agree with Pink Bear. I too was OK on Eltroxin but was made ill by MP and I too, am not confident enough to try it again and will wait and see what is said about it in future.

Many thanks Rod.

[veronicahoward]

The confusion lies with the pharmaceutial companies not with the patients. I have emailed them and referred them to this site to see the thousands of articulate people who are being sidelined by the health services and having to resort to self medication to get a more effective choice. I have also pointed out that I did not pay into the health service and still pay Central Governement and Local Government taxes, to have to shell out on medication from abroad in order to sustain good health. Further I have stated that sometime soon I will be setting up a legal challenge to recoup monies spent because of the deficit in the system.

[Clutter]

If the ingredients are identical in Eltroxin and generic Levothyroxine why do AmCo continue manufacturing Eltroxin?

[helvella in reply to Clutter]

Why produce Eltroxin as well as levothyroxine? There is one over-riding reason – money.

I am sure that both Eltroxin and levothyroxine cost effectively exactly the same to make. Somehow, by being regarded as the leading branded product, Eltroxin has managed to command a higher price. So they keep making it because they can charge more! But “keep making” only really means “keep differently packaging”. The incremental price is pure profit.

Some few years ago, Mercury Pharma (when they were called Goldshield) switched from selling Tertroxin branded liothyronine to a simple generic. No change whatsoever. No overlap. A straight swap. In the years since, we have seen the price rise from around £15 for 28 tablets to somewhere approaching £130. This has been achieved because the price controls that apply to NHS purchasing of branded medicines does not apply to generics. So a very simple, purely packaging/naming change has resulted in a massive price rise.

What if MP now decide to abandon Eltroxin and increase the price of levothyroxine? The only mechanism I can see to keep the price down is competition. If they increased the price from £2 to £20 for 28 tablets, we can be pretty sure that Actavis would increase sales volume massively. But if MP increased the price from £2 to, say, £3, then Actavis might think it worth almost matching that – maybe £2.75? After a while, MP sales might reduce a bit but they could easily match the new Actavis price of £2.75 and still have achieved a price increase of around 37%. A duopoly can act very like a monopoly in many cases even without any illegal behaviour such as price fixing.

Also, remember that many companies produce multiple competing products. There are two major laundry product companies - Unilever and Proctor and Gambol. But how many different products appear in the shops? Far more than two.

Rod

[Clutter in reply to helvella]

I thought it might be to evade branded price controls.

I simply don't understand why the manufacturers of Tiromel, Cytomel etc. don't apply for UK licenses to distribute T3 in competition with AmCo.

[helvella in reply to Clutter]

Pfizer/King charge a similar price for Cytomel as MP do for their liothyronine. I have been thinking that has been MP's "target" price.

The other USA products are actually not far behind despite being the "generic" competitors - in fact, I seem to remember seeing one of them actually had nudged slightly ahead of Cytomel!

Despite the high price, the actual money spent by the NHS on liothyronine is not huge. According to the March 2014 figures here:

nhsbsa.nhs.uk/PrescriptionS...

Total cost was about £985,529.80.

I imagine that the costs of applying for a license plus then establishing distribution would be significant. If selling at a highly competitive price, instead of almost a million a month at MP prices, maybe there would be a market of £100,00 at current Thybon Henning prices (buying from Germany), or considerably less at the sort of prices we hear about in Turkey. Very much less attractive for a competitor to launch.

I happen to think that the best placed competitor might be Sanofi who already sell both their version of Cynomel in France and Thybon Henning in Germany. They could probably launch either in the UK with relative ease. They already have a commercial presence in the UK.

If anyone does launch, let us hope they make life easier for many and offer 5 and 50 mcg tablets as well as 20.

Rod

[Clutter in reply to helvella]

If I was Abdi Ibrahim I'd be evaluating the cost and conditions of licensing and distribution if I could sell my 70Lire product for anywhere near £100 and undercut AmCo.