Liothyronine brands available via the NHS

[pandacat2]

Hi there,

I've recently managed to acquire an incredibly elusive NHS Liothyronine prescription. It took me a while to prove I needed it but my GP has agreed to a shared care agreement with a private GP I see who specialises in Thyroid disease treatment.

I'm taking 40mcg of Liothyronine spread across the day in 4 doses, with 112mcg of levothyroxine in the morning. This regimen was working really well for me when taking Thybon Henning liothyronine.

I've received my first prescription via the NHS and I've been sent 10mcg tablets of Roma Pharmaceuticals Liothyronine Sodium, I've been slowly switching to this whilst I run down my supply to Thybon Henning but have started noticing a return of tinnitus and foot pain, which for me seem to be the first indicators of being under medicated.

Does anyone know anything about a difference in potency of the two versions of the medication? I realise they are different formulas, one being Hydrochloride and the other Sodium.

I'm wondering if I could request Morningside for my next prescription and see if that works better for me. I've been looking at the drugs tariff this morning and presuming that the 20mcg tablets referenced there are Morningside (not sure why there is no brand name against it? Any ideas? Does this mean it's a generic? ) it would be way cheaper which I'm sure would appeal to my NHS GP.

Sorry that was very long, any advice much appreciated.

------

I have tried to attach the image of the drugs tariff many times but it won't let me no matter what file type it is. I just wanted to show you that there is a blank space on the right next to the 20 mcg tablets, where the other brand names are you can see it if you scroll down on this webpage:

drugtariff.nhsbsa.nhs.uk/#/...

[helvella]

That bit is blank because there is nothing to say! It is Category M which means:

Category M

This category lists drugs which are readily available.

The reimbursement price is calculated by the Department of Health and Social Care (DHSC) based on information submitted by manufacturers.

So that price applies to ALL makes.

Given that Morningside 10 microgram tablets cost around three times the Roma capsules, I think you'll find it difficult to persuade anyone to prescribe and supply them.

helvella's medicines documents (UK and Rest of the World) can be found here:

helvella - Thyroid Hormone Medicines

helvella has created, and tries to maintain, documents containing details of all thyroid hormone medicines in the UK and, in less detail, many others around the world.

This link takes you to a page which has direct links to the documents from Dropbox and Google Drive, and QR codes to make it easy to access from phones.

The UK document contains up-to-date versions of the Summary Matrix for tablets, oral solutions and liothyronine available in the UK.

helvella.blogspot.com/p/hel...

Screenshot of drugs tariff extract for liothyronine

[pandacat2 in reply to helvella]

HI Helleva,

Thanks for your reply. I'm afraid I don't understand what that means re Category M, think I'm a bit out of my depth here. Are there any 20mcg tablets that can be split available via the NHS?

I realise the 10mcg Morningside are incredibly expensive, I'd need 4 packs of that a month too which no one is going to agree to (£609.76 😅)

Ultimately I'm wondering if there is an alternative brand available on the NHS that I could be prescribed if the Roma really isn't working for me.

Thank you

[helvella in reply to pandacat2]

Category M means simply that there are several makes, and they are all going to be reimbursed at the same price.

The Category C is for specific products - in this area, where there is only one make.

Remember, though, that the Drug Tariff is almost invariably well behind reality.

Afraid I don't take liothyronine so am not familiar with splittability of the various makes.

What are the categories of drugs in the Drug Tariff?

There are 3 categories of drugs in the Drug Tariff, categories A, C and M.

Category A

This category lists the drugs that are readily available.

The reimbursement price for each of these drugs is calculated from a basket list of suppliers.

Category C

This category lists drugs that are not readily available as a generic and their price is based on a particular brand or supplier.

Category M

This category lists drugs which are readily available.

The reimbursement price is calculated by the Department of Health and Social Care (DHSC) based on information submitted by manufacturers.

faq.nhsbsa.nhs.uk/knowledge...

[pandacat2 in reply to helvella]

Ah ha! That makes sense, thanks for taking the time to explain, I really appreciate it. Hopefully someone else can advise on which makes can be split.

[TaraJR in reply to helvella]

helvella this is a really good explanation.

But one question - The pharmacist gets reimbursed for dispensing, according to the info you have given above. But who pays the pharmacist? Does the money come from DoHSC, or the pharmacist's ICB? I.e. is it charged centrally, or to the local area which will have its own policies on prescribing?

[helvella in reply to TaraJR]

In England, the payments are handled by the NHSBSA:

nhsbsa.nhs.uk/

Specifically, their Prescription Services arm:

nhsbsa.nhs.uk/nhs-prescript...

However, I do not know how they handle financing - whether they add it all up and pass the bill to someone else, or something else. Nor how the ICB figures in all this.

Maybe the dispensing fees (i.e. payment for handling the prescription rather than the cost of the medicine) is handled differently?

And Northern Ireland, Scotland and Wales are different...

I'd really like a Janet and John level introduction to how the NHS does these things. And good children's authors around?

[TaraJR in reply to helvella]

Thanks, you amaze me! What a complicated system. Think I'll try to ask one of my local pharmacists, when they're not run off their feet. It'd be good to know.

[helvella in reply to TaraJR]

It is complicated! But having one organisation (in England) that handles the bits of paper does seem quite sensible. Even if everything else changes, someone has to do that drudgery with paper. (Even if it gets fully computerised, it is still drudgery!)

[Star13]

I’m assuming if you were on Thybon Henning that you split those tablets successfully? That being the case I assume you would want to stay on them? I am prescribed TH on the NHS and can give you the details of the pharmacy who sends them to me. Your GP can send the script to them electronically as they would any other prescription and they will pay the same price as all other T3 medications.

[pandacat2 in reply to Star13]

Hi Star 13,

I had (obviously incorrectly) assumed that I couldn't get Thybon Henning from the NHS as it's an unlicensed medication. If you could send me the details of the pharmacy that would be brilliant, will I need to ask the GP to specify the brand in the prescription?

Do you get the 100 tablets box of 20mcg tablets?

Thanks so much!

[helvella in reply to pandacat2]

The prescriber has to be willing to fight their corner in order to do so.

But that just makes it difficult - not impossible. (Might not need to fight, but they could face criticism for prescribing it.)

[Star13 in reply to pandacat2]

I’ll PM you.

[Reefseeker]

Is it possible you have any sort of intolerance to the gelatin? I am prescribed liothyronine on the NHS from a hospital endo, but have a serious reaction to the gelatin capsules in Roma, which the local hospital issues due to its lower cost. The hospital pharmacy has to make a special order for mine each time from Mercury pharmacy. They seem to issue 20mcg. I am on 150mcg T4 and 40mcg liothyronine split into 2 doses daily (I can't keep up with 4 doses daily!).

[mandy-white in reply to Reefseeker]

I am exactly the same.

[pandacat2 in reply to Reefseeker]

I don't think I'm intolerant of the gelatin, it's not causing any other issues than feeling under medicated. Think I'll try to switch to a different brand and see how it goes.

Re dose splitting, I have a series of alarms set on my phone each day to remind me, I used to take it in three doses but found I was getting a morning crash. The 4 doses made a big difference.

[Reefseeker in reply to pandacat2]

It will be so good if you can get a brand more suited to you, good luck 👍

Re: split doses, my problem is I can't space it all out enough between food, caffeinated drinks, vitamin supplements and, of late, calcium in tea and cereals (I've only just found out, via the Thyroid Patients Canada website I think, about calcium and absorption). Were I not addicted to my 4 cups of tea a day, it might be much easier! I too get a late morning crash.

[SlowDragon Administrator]

Several members have found Roma brand does not suit them and successfully gone back to previous brand

If you can’t get Thybon Henning on NHS prescription

Three brands available at 20mcg - Morningside, Teva or Mercury Pharma

2 x 20mcg would be substantially cheaper

Just cut in half to get 10mcg doses

[pandacat2 in reply to SlowDragon]

Thanks SlowDragon that's super helpful. Good to know I'm not alone re the Roma, thought it would be more convenient not having to split tablets so was initially quite excited by the 10mcg tablets, shame they aren't working out for me.

I think the fact that it's cheaper will help my argument re switching to one of those brands. If they also don't work for me I'll try to get the Thybon.