Liothyronnine on Radio 4 this morning's 'Today... - Thyroid UK

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Liothyronnine on Radio 4 this morning's 'Today' programme 7.16am. CMA has fined Advanz + 2 private equity companies total of £100million.

tattybogle profile image

:) ** NEWSFLASH** Lynn mynott needs someone to talk to the media healthunlocked.com/thyroidu... case-study-needed-urgently

49 Replies

Hi there - why ? Price fixing - not sure

"for their part in driving up the price of liothyronnine tablets from £20 in 2009 to £248 in 2017" interview with someone from CMA.... good bit about patient's having to buy their own..

gov.uk/cma-cases/pharmaceut... cma-cases/pharmaceutical-sector-anti-competitive-conductCase timetable

Date Action

29 July 2021 Infringement Decision issued: unfair pricing abuse in relation to Liothyronine tablets

gov.uk/government/news/cma-... press release;

"....The price increases were not driven by any meaningful innovation or investment, volumes remained broadly stable, and the cost of producing the tablets did not increase significantly. NHS spending on the tablets in 2006, the year before the implementation of the strategy, was £600,000, but by 2009 had increased to more than £2.3 million and jumped to more than £30 million by 2016.

Eventually the drug was placed on the NHS ‘drop list’ in July 2015. This led to patients being faced with the prospect of having their current treatment stopped or having to purchase liothyronine tablets at their own expense. That is particularly concerning, given that many patients do not respond adequately to the main treatment for hypothyroidism, levothyroxine tablets and instead rely on liothyronine tablets to alleviate symptoms such as extreme fatigue and depression."

Andrea Coscelli, Chief Executive of the CMA, said:

“Advanz’s decision to rachet up the price of liothyronine tablets and impose excessive and unfair prices for over eight years came at a huge cost to the NHS, and ultimately to UK taxpayers. But that wasn’t all – it also meant that people dealing with depression and extreme fatigue, as a result of their thyroid conditions, were told they could not continue to receive the most effective treatment for them due its increased price.

Advanz’s strategy exploited a loophole enabling it to reap much higher profits. This fine of over £100 million, and our work in the pharma sector to date, sends a clear message that breaking the law has serious consequences.”

As well as imposing substantial fines, the CMA’s decision makes it easier for the NHS to seek compensation for the firms’ behaviour, by way of damages, should it choose to do so. "

Notes to Editors

1) The CMA has decided to impose financial penalties on Advanz Pharma Corp and three of its subsidiaries, as well as HgCapital and Cinven. Specifically, the CMA requires the parties to pay a total penalty of £101,442,899 in relation to the infringement which occurred between 2009 and 2017, with each of them being liable for the following amounts:

i) Advanz Pharma Corp and three of its subsidiaries are liable for a penalty of £40,942,899;

ii) HgCapital is liable for a penalty of £8.6 million; and

iii) Cinven is liable for a penalty of £51.9 million.

2) The CMA is addressing the decision to Mercury Pharmaceuticals Limited, Advanz Pharma Services (UK) Limited, Mercury Pharma Group Limited and Advanz Pharma Corp. Limited, as well as to HgCapital LLP and to Cinven (Luxco 1) S.A., Cinven Capital Management (V) General Partner Limited and Cinven Partners LLP. 2.

4) In 2007, Advanz developed what it termed a ‘price optimisation’ strategy. This involved identifying genericised drugs with limited or no competition and high barriers to entry. By ‘de-branding’ these drugs, it could remove them from the price regulation regime which only applied to branded drugs, enabling it to set whatever prices it chose. "

Hibs1 profile image
Hibs1 in reply to tattybogle

Ha, I was just about to post the link

helvella profile image
helvellaAdministrator

Am so very pleased to read a conclusion. (I hope there is no room for appeals, etc.)

Whilst 100 million is:

a) a lot of money;

b) much less than the hydrocortisone case (260 million);

c) regarding a much less widely prescribed medicine than hydrocortisone -

perhaps this does fire a shot across the bows? I'd like to think that commentary alongside implies any future such transgressions will ramp up the scale of fines even more substantially.

And I would like to see the individuals involved suffer the consequences. The patients and NHS coffers have already suffered deeply. And with the consequent de-prescribing of liothyronine, patients who need liothyronine will continue to suffer for many more years.

humanbean profile image
humanbean in reply to helvella

I would like to see the individuals involved suffer the consequences.

Didn't one of them get a knighthood?

SlowDragon profile image
SlowDragonAdministrator in reply to humanbean

An OBE ….unbelievable

They should be stripped of titles when they are proven to have committed crimes.

SlowDragon profile image
SlowDragonAdministrator in reply to humanbean

A rudimentary search would have revealed this

bbc.co.uk/news/uk-politics-...Officials vetting a businessman for an OBE were not aware of newspaper claims his firm had overcharged the NHS for drugs, the BBC has learned.

Dr Vijay Patel was named in the 2019 New Year Honours List for services to "business and philanthropy".

Three years earlier, his firm had been on the front page of The Times in an investigation into price fixing.

SlowDragon profile image
SlowDragonAdministrator

Here’s an article just published

eminetra.co.uk/cma-fines-ph...

The CMA has fined the companies involved for a total of over £ 100m during the relevant period in violation of the law. Advanz (£ 40.9m), HgCapital (£ 8.6m), Cinven (£ 51.9m) – Two private former business owners are now part of Advanz.

Finally, the drug was listed on the NHS “Drop List” in July 2015. This faced the prospect that patients would have to discontinue their current treatment or buy liothyronine tablets at their own expense. Many patients do not respond appropriately to levothyroxine tablets, the main treatment for hypothyroidism, and instead rely on liothyronine tablets to relieve symptoms

helvella profile image
helvellaAdministrator in reply to SlowDragon

From that link:

The CMA’s decision not only imposes large fines, but also makes it easier for the NHS to seek compensation for corporate behavior if it chooses to pay damages.

I sincerely hope the NHS takes the companies to court over this, the hydrocortisone issue and anything else for which it might be possible.

SlowDragon profile image
SlowDragonAdministrator in reply to helvella

And a group court case for all thyroid patients who had their T3 prescription stopped on NHS and forced to get on private prescription

helvella profile image
helvellaAdministrator in reply to SlowDragon

I agree.

It won't happen but a case led by the NHS with affected patients as joint claimants would seem appropriate. And it should include not just those for whom the impact was not because they bought liothyronine in the UK, but also those who were refused liothyronine on the grounds of cost, etc.

Tythrop profile image
Tythrop in reply to SlowDragon

Hear Hear Slow Dragon. Also I want yo to see the Actual People behind the companies named and shamed.. I want them to face public humiliation

SlowDragon profile image
SlowDragonAdministrator in reply to Tythrop

At very least name removed from this building

dmu.ac.uk/research/research...

I have some friends in Bristol who are good at that sort of thing .. i'll have a word.

Tythrop profile image
Tythrop in reply to SlowDragon

Yes yes yes. "donations" or inducements or, as Bob Dylan sang "tax deductable charitable donations"

Mistydeb01 profile image
Mistydeb01 in reply to Tythrop

And the NHS buying team should be investigated for allowing such a price hike breeze through the system. Stinks of backhanders or benefits of some kind

helvella profile image
helvellaAdministrator

Article in Guardian - doesn't add much:

theguardian.com/business/20...

gov.uk/government/news/cma-...

Does this mean the price of NHS liothyronine will now be dropped back to something more reasonable?

helvella profile image
helvellaAdministrator in reply to StitchFairy

Excellent question but the fine only applies up to 2017.

So it will be interesting to see what happens.

it has already been gradually falling from the £248 peak to about £111 (ish ?) , because there are now 3 manufacturers, not just one. Personally i doubt it will ever fall back to what it 'ought' to be .

SlowDragon profile image
SlowDragonAdministrator in reply to tattybogle

It’s currently £101 per 28 tablets

That's still a totally ridiculous price!

Is a replay available ? I’ve had my T3 stopped even though an endo prescribed it . It’s crazy

helvella profile image
helvellaAdministrator in reply to reikimaster

bbc.co.uk/sounds/play/m000y6rq

That link is for the WHOLE program and will only be generally available in the UK. I think you will have to go to around 07:15.

reikimaster profile image
reikimaster in reply to helvella

Thanks for this I’m looking for it now 😉

SlowDragon profile image
SlowDragonAdministrator

good YouTube video by Competitions and marketing authority on the scandal

youtu.be/5yiXeY0p8Og

helvella profile image
helvellaAdministrator in reply to SlowDragon

Worth a watch - I suspect CMA are getting their argument against Advanz, et al., in ahead of an appeal.

Sorry just posted the BBC link separately. This is AMAZING

URGENT lyn mynott needs somebody who's had T3 withdrawn or refused , to talk to a journalist. healthunlocked.com/thyroidu... case-study-needed-urgently

JaneChapple

CaroleM-A

annca1

Flecmac

1123ayoung

from looking at some recent posts these members may? be in that situation lynmynott

knitwitty profile image
knitwitty in reply to tattybogle

I have emailed her !

SlowDragon profile image
SlowDragonAdministrator

Great in-depth article by Billy Kenber at The Times

Behind paywall unfortunately

thetimes.co.uk/article/uks-...

Hopefully Thyroid U.K. and Thyroid Trust will get a link up to it

lynmynott

TaraJR profile image
TaraJR in reply to SlowDragon

The Times article by Billy Kenber:-

A drug company exposed by The Times for increased the price of a “life-changing” thyroid drug from 16p to £9.22 per tablet has been fined more than £100 million.

Thousands of patients were denied access to liothyronine and had to travel abroad to buy it after price rises imposed by Advanz Pharma led to restrictions on prescriptions.

The company, previously known as AMCo, exploited a loophole in NHS pricing rules to increase the price of liothyronine by 5,600 per cent, costing the NHS an extra £115 million over nine years.

The drug is used by at least 13,000 patients who have an underactive thyroid and do not respond to the primary treatment for the condition.

The Competition and Markets Authority (CMA) said Advanz had charged “excessive and unfair prices” for nearly a decade, with the price rises not justified by “any meaningful innovation or investment” or significant increase in the cost of production.

Andrea Coscelli, chief executive of the CMA, said “Advanz’s decision to ratchet up the price of liothyronine tablets and impose excessive and unfair prices for over eight years came at a huge cost to the NHS, and ultimately to UK taxpayers”.

He said it meant that “people dealing with depression and extreme fatigue, as a result of their thyroid conditions, were told they could not continue to receive the most effective treatment for them due to its increased price”.

The CMA handed Advanz a £40.9 million fine, with two private equity companies who previously owned the business, HgCapital and Cinven, fined a further £8.6 million and £51.9 million respectively.

The fines cover the period from 2009 until 2017 although the CMA said the price rise began in 2007.

If upheld on appeal, the fines will go to the Treasury rather than directly to the NHS but the Department of Health and Social Care could now take civil action to reclaim the money it overpaid for the drug.

The CMA’s inquiry was opened after a Times investigation in 2016 exposed how AMCo and other companies were increasing the price of old medicines by dropping the brand name and relaunching them as unbranded generics.

The NHS imposes restrictions on the pricing of branded medicines but relies on market forces to keep down the cost of these drugs, which are not protected by patents.

Several drug companies, including AMCo, realised that they could use this loophole to obtain the rights to old, niche medicines with little or no competition and impose repeated price increases.

Liothyronine cost less than £16 for a packet of 100 tablets before being relaunched at about £20 for 28 tablets. A series of price rises increased the price to a peak of £248 per packet.

AMCo’s business model involved targeting such drugs and often imposing large price rises under what it termed a “price optimisation” strategy.

In 2012 John Beighton, chief executive of AMCo at the time, and a colleague, gave a presentation at a healthcare conference in which they outlined the model.

The company focused on drugs, which other companies would find difficult to manufacture or had not taken an interest in because of the small market size. The PowerPoint slideshow highlighted the loophole in NHS rules, which meant that there was “unrestricted pricing on unbranded products” and a drug could be debranded to place it into this category.

The price rises for liothyronine led the NHS to place the drug on its “drop list” in July 2015, raising the prospect of patients having their treatment stopped.

Although national restrictions were not imposed, many health commissioners told doctors to reduce or stop prescriptions because of the cost.

Patients were instead forced to buy it from online pharmacies or travel to European countries such as Greece where a packet costs a few euros.

Tara Riddle, 70, who is retired and lives near Norfolk, had to buy liothyronine online after her GP told her in 2016 that he could no longer prescribe the drug.

Describing her symptoms before she first took liothyronine, she said: “I couldn’t get out of the house, I couldn’t get off the sofa.” She said that she had extreme fatigue and “brain fog” when not on liothyronine.

“I couldn’t stand unsupported [because] I was so weak and exhausted. The brain fog was horrendous — I had to stop driving [and] if I’d been working I’d have had to stop,” she said.

After her prescription was stopped she felt she had no choice but to buy it online or from abroad. “What choice have you got, to have no life or take a risk?” she said.

Riddle, who is a co-leader of the campaign group Improve Thyroid Treatment, fought a long battle with local health commissioners and was able to get her prescription reinstated last year but patient groups said that as many as half of clinical commissioning groups were still limiting access to the drug.

Lorraine Williams, director of the Thyroid Trust, said the charity had spoken to hundreds of patients who were denied the “life-changing” drug.

“The recurring theme is that they feel their life is not worth living when they haven’t got this treatment,” she said.

Williams welcomed the fine, adding: “It’s vindication for patients that the system does care and will actually stand up for patients’ needs because they have felt abandoned.”

The CMA’s decision follows a record fine of more than £260 million imposed this month on several drug companies including Advanz Pharma who colluded to increase the price of hydrocortisone tablets by 12,500 per cent.

A packet of liothyronine tablets costs the NHS about £100 even though two other manufacturers, Teva and Morningside Healthcare, have launched their own versions in recent years.

Under legislation passed in 2017 in response to the Times exposé, the government obtained powers to impose lower prices if it believed the NHS was being exploited but has yet to use them.

A spokeswoman for Cinven said it “strongly disagrees with the CMA’s findings” and would appeal. HgCapital declined to comment.

Advanz Pharma said price increases had been made in agreement with the Department of Health and Social Care and it planned to appeal. The company said it took competition law very seriously and had always acted in the interests of patients.

“We utterly disagree with the CMA’s decision on the pricing of liothyronine tablets and will be appealing,” it added.

It said it had invested significantly to keep the medicine on the market and all price rises were “pre-notified to, and agreed in advance and in writing by, the [DHSC]”.

The Times has previously obtained emails showing that NHS officials waved through large medicines price rises imposed by Advanz Pharma when known as AMCo without asking for a justification.

mstp profile image
mstp in reply to TaraJR

I find the mention of 'depression and fatigue' as the symptoms a bit irksome given the all round consequences of a thyroid not working properly. I always say that my symptoms started at the top (hair falling out) and worked their way down my body so (in addition to the depression and fatigue) I have suffered severe brain fog, an inability to concentrate and memory problems; a constantly changing mood and an inability to cope with much pressure (which was a nightmare for all concerned when trying to rear two young children); dry eyes; psoraisis; aching legs and joints and stiff fingers; weight gain; malabsorption of food resulting in constipation and gastric problems bought on by low stomach acid which ultimately led to crippling vitamin and mineral shortages, swollen tongue and sensitivities developing to a lot of foods. These are the ones I can recall off the top of my head. I am sure there were others which will no doubt come to me in the next few days. As I say, it is rather irksome to wrap it all up in the term 'depression and fatigue'....

Times article is currently readable via link in this post

healthunlocked.com/thyroidu...

....including the comments :)

i like this one

" Andrew Middlemiss

18 HOURS AGO

Only £100 million ? Perhaps it should be increased by 6,000% as a salutary lesson. "

Haha, love it. Wouldn’t that just bite them in the ass

600,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,0... o i've ran out of noughts.. but they could probably still afford it.

Just a thought!

"They" will probably try and squirm their way out of this with the power of filthy lucre and fine words behind them....pay the fine and carry on!!

Who, in the first instance, provided the loophole that allowed this price hike to legally take place?

In essence "they" appear to have the law on their side, they exploited someone else's blunder!!

Advanz’s strategy exploited a loophole enabling it to reap much higher profits. This fine of over £100 million, and our work in the pharma sector to date, sends a clear message that breaking the law has serious consequences.”

They are morally wrong but can they be found to be legally wrong?

The Times has previously obtained emails showing that NHS officials waved through large medicines price rises imposed by Advanz Pharma when known as AMCo without asking for a justification.

What a mess! Why did NHS officials allegedly wave through the large price rises?

Who were these people?

Feels like the pot calling the kettle black!

This development has to be a game changer ....but how and when, that's what matters to patients.

Unless the vastly inflated price drops significantly or more (viable) sources become available ... nothing really changes for patients who sadly are pawns in this miserable battle.

It will be a long battle I suspect but we live in hope

Metaphorically, I'm wearing my battered cynic's hat this morning!

Fingers crossed

DD

helvella profile image
helvellaAdministrator in reply to DippyDame

"They" will probably try and squirm their way out of this with the power of filthy lucre and fine words behind them....pay the fine and carry on!!

Pay the fine? Only if they lose the appeal they have said they are launching. (No idea what the appeals process is for CMA decisions.)

DippyDame profile image
DippyDame in reply to helvella

Probably...pay the fine.

Yes I understand, I expressed that badly.

mstp profile image
mstp in reply to helvella

Sometimes sentences (fines) can be increased on appeal. Could we press for this maybe?

tattybogle profile image
tattybogle in reply to DippyDame

If /when they do cough up .. it goes to the treasury. "Dear Rishi Sunak.. i hear you are anticipating had a nice little windfall, if it materialises please will you buy us some T3 ?

p.s i know it's still really expensive here, so you'll get better value for your money if you have some sent over from Germany or Turkey in a diplomatic box.

Thanks in anticipation...."

Having said that ...... i wonder how much it's cost the CMA to get this far ? I do hope they are making Advanz 'et all' pay their legal cost's , but haven't seen anything to that effect.

helvella profile image
helvellaAdministrator in reply to tattybogle

I do not know how the costs are dealt with - it isn't a court in the conventional sense so our usual expectaions based on court reports might not apply.

However, Advanz are appealing. (In one sense of the word,. :-) ) Therefore they possibly do not have to pay until that route is exhausted. I just emailed the CMA to ask about their appeals processes - no idea about them.

If I were you, I'd contact the CMA and ask.

DippyDame profile image
DippyDame in reply to tattybogle

The Treasury always have their hand out ...

This will never be about the thyroid patient, sitting quietly at home, and feeling miserable from lack of T3 ...

Too many snouts in the trough.

Only just found this and have emailed Lynn Mynott

It concerns me that people who can blatantly rip off the state and cause so many innocent people such distress and ill health, can sit with an OBE and feel proud. He should hang his head with shame.

So, is the NHS going to reinstate T3 "effective treatment" for those that have had it removed?

Are the NHS going to properly assess patients needs...it clearly states above " Andrea Coscelli, chief executive of the CMA, said “Advanz’s decision.....meant that “people dealing with depression and extreme fatigue, as a result of their thyroid conditions, were told they could not continue to receive the most effective treatment for them due to its increased price”.

Are the NHS going to drive the price down to something sensible?

£100 million sounds high to mere mortals but to pharma it is not: does this recoup the total profit made and more gauged out of the tax payer?

It's easy to want more, but it is excellent that the CMA has done something. I can stop haranguing my MP!

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