Hello
Every year or two Boots like to give me a hard time ,a few years ago they said that they cant get Mercury pharma, ( after help from a member on here) my GP added Advanz Mercury pharma,Now Boots are saying they want Advanz Mercury pharma written at the top of the proscription infront of liothyronine. Then they said Advanz liothyronine costs so much more than the other brands.
All the best
Frank
There is some truth that they can only claim if the prescription is written in the right way. Otherwise they can only claim the basic T3 price.
See Appendix E in my UK medicines document. It is written for Levothyroxine, but the process is the same.
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. There is now a specific world desiccated thyroid document.
I highly recommend viewing on a computer screen, or a decent sized tablet, rather than a phone. Even I find it less than satisfactory trying to view them on my phone.
helvella - Thyroid Hormone Medicines - UK
The UK document contains up-to-date versions of the Summary Matrixes for levothyroxine tablets, oral solutions and also liothyronine available in the UK. Includes injectables and descriptions of tablet markings which allow identification. Latest updates include all declared ingredients for all UK products and links to Patient Information Leaflets, etc. PLUS how to write prescriptions in Appendix F.
dropbox.com/s/bo2jzxucgp9hl...
helvella - World Desiccated Thyroid
Contains details of all known desiccated thyroid products including information about several products not considered to be Natural Desiccated Thyroid (NDT/Desiccated Thyroid Extract/DTE).
dropbox.com/scl/fi/gx6dmz5i...
helvella - Thyroid Hormone Medicines - RotW
Contains details of all levothyroxine, liothyronine and combination products - excluding desiccated thyroid products. Details available vary by country and manufacturer.
dropbox.com/s/dliou4fszbegw...
The link below takes you to a blog page which has direct links to the documents from Dropbox and QR codes to make it easy to access from phones. You will have to scroll down or up to find the link to the document you want.
Last updated 19/07/2024
helvella.blogspot.com/p/hel...
Thank you very much Helvella.
Looks like I have a lot to learn
Thanks for your help!
Frank
You shouldn't have to know this, or find it out.
And not that many years ago, I knew nothing of all this.
I just read this "Advanz pushed up the price of thyroid tablet packs from £20 in 2009 to £248 in 2017, making the drug unaffordable for the NHS."
Sure did.
They de-branded from calling it Tertroxin to just Liothyronine. By doing that, they escaped the price controls that apply to branded medicines bought by the NHS.
The theory was that competition would keep the prices down. But there was no competition. They had a monopoly so could charge whatever they wanted to.
helvella - Historical Prices of Liothyronine Tablets in the UK
Historical prices of liothyronine in the UK from 2005 through 2023.
helvella.blogspot.com/p/hel...
I remember 5 or 6 years ago I was told by a pharmacist in Germany that T3 was 28 euro a pack, I think there was 100 tablets in a pack, I could be wrong about the number.
Last I looked, Thybon Henning was 31 euros for 100 in Germany. Could well have been 28 a while ago.
Uni pharma T3 was £1.65 a pack about 7/8 years ago from a German pharmacy. Criminal that that while I could purchase a very good quality box of t3 for that price. The nhs were getting ripped off paying £248 for same quantity.
I still think this is partly to blame for today's resistance for prescribing t3, just my take on it.
Advanz pharma should have been more than fined!
Advanz liothyronine costs so much more than the other brands.
I think my response to that would be to meet their gaze and say, oh so calmly, “Are you saying I’m not worth it?”
Like there’s anything you can do about the price. How is that your fault?
Stand firm. You definitely are worth it. 🙂
in theory all 3 brands of liothyronine 20mcg tablets licensed for use on NHS are the same price
Not sure how much they vary in practice
Current prices here
healthunlocked.com/thyroidu...
Because the NHS Drug Tariff price so often seemed at variance with the quoted prices (e.g. as quoted by members), I have added links to the NHS dm+d database to my UK medicines document. (dm+d = Dictionary of Medicines and Devices.)
The dm+d contains official prices by product - shown in pennies for 28 tablets. And I have just extracted them as below:
Liothyronine 20microgram tablets (Advanz Pharma) 28 tablet
9500
dmd-browser.nhsbsa.nhs.uk/a...
Liothyronine 20microgram tablets (Morningside Healthcare Ltd) 28 tablet 2 x 14 tablets
9500
dmd-browser.nhsbsa.nhs.uk/a...
Liothyronine 20microgram tablets (Strides Pharma UK Ltd) 28 tablet 2 x 14 tablets
4010
dmd-browser.nhsbsa.nhs.uk/a...
Liothyronine 20microgram tablets (Teva UK Ltd) 28 tablet
6785
dmd-browser.nhsbsa.nhs.uk/a...
Liothyronine 20microgram tablets (Viatris UK Healthcare Ltd) 28 tablet
14714
dmd-browser.nhsbsa.nhs.uk/a...
These can vary and the dm+d data is the most up to date we have access to.
helvella - Thyroid Hormone Medicines - UK
The UK document contains up-to-date versions of the Summary Matrixes for levothyroxine tablets, oral solutions and also liothyronine available in the UK. Includes injectables and descriptions of tablet markings which allow identification. Latest updates include all declared ingredients for all UK products and links to Patient Information Leaflets, etc. PLUS how to write prescriptions in Appendix F.
dropbox.com/s/bo2jzxucgp9hl...
Significant price variation …..how do they justify I wonder
I happen to be on one of cheaper ones……Teva …..and lactose intolerant so they have to honour it
Download the BNF app from app store. You can see both NHS indicative price ( where given) and drug tariff price for all medications. Type in name of medication then tap Medicinal Forms near bottom of list. Each dose is priced. Lots of other good information to read too
The BNF prices are not easy to follow.
You cannot readily link the listed product with the actual formulation and what it says on the packaging! I've attached the entry shows one product under Medihealth. But there is no indicative price and no obvious way to identify the actual product the the distributor Medihealth would supply and whether that would be just one product. It certainly is NOT a product branded as Medihealth.
Plus, there is a time delay between actual changes in prices and them being included in BNF.
That is why I have added direct links from my medicines document to the dm+d databases for all UK licensed thyroid medicines that are on the dm+d database. (Occasionally there are hiccups in data flow but officially all products should be on dm+d within a few days of any change - and often ahead of real world changes.)
I know you produce a very updated and detailed list of thyroid medication costs for the members which is greatly appreciated
I only mentioned as it's very simple app to use to look up a quick reference for any medication you might want to read about. I came across the app from a menopause group which helped me greatly back then. It's very simple and great for reading up other information too. It's so much simpler than the website.
I struggle to read or understand stuff these days so the app is helpful for me.
Still haven't a clue about indicative and drug tariff price, what the both mean and if this is the reason why chemists won't supply certain brands because they are out if pocket doing so 🤷🏼♀️
That is why, every month, I add the latest prices to my blog. That is a very simple table.
I find the BNF listing very confusing because of the mismatch between the company names and actual products as we know them.
Current NHS Drug Tariff Liothyronine Prices
Link to a blog post of Monthly NHS Drug Tariff prices for Liothyronine products from January 2023 onwards.
Also includes link to information for Northern Ireland and Scotland. (Wales' data is based on England.)
helvella.blogspot.com/p/cur...
Last updated 30th July 2024
Hello correct me if I am wrong ,am I right in thinking Liothyronine 20microgram tablets (Advanz Pharma) 28 tablet costs £95?
9500
Yes - that is the NHS Indicative price.
But, if I have understood correctly, the pharmacy would only be reimbursed £60.43 if prescribed as 20microrgam Liothyronine tablets. Leaving them with a potential significant loss.
However, if the product is prescribed properly by brand, they should get the full price.
(There's all sorts of percentage adjustments here and there as well. And dispensing fees. Which makes it completely impossible for us to be spot on.)
If any pharmacists are hanging about - feel free to correct me!
Does anyone know why people like myself cant change brands without getting ill?
Sometimes we can see a particular issue - for example, someone who is acacia-intolerant getting a product which contains acacia! A problem there being few would ever have realised they were acacia-intolerant until taking medicines which contain it - on a regular basis. It is not widely understood or appreciated.
But, all too often, we have no idea.
And it could be factors other than the direct effects of ingredients. For example, the rate at which we can absorb the active ingredient. And the completeness.
If we absorb quickly, the peak levels in our blood will be higher, which might not feel good.
If we do not absorb as completely, we end up with effectively a lower dose. But switching to a product we absorb more completely could result in a slight over-medication.
There are many, many factors and few have been fully investigated - let alone specifically with regard to thyroid hormones.
Oh that would be great if a pharmacist would explain to us.My scripts have brand Morningside only wrote on but no one local can supply the amount i require.
I use Springfield and I think they are recouping some charges from me via the postage charge. It varies every month. Last charge was over £16. I'm fine paying whatever as long as I get Morningside.
I know another member doesn't pay anything but they have a different brand. They don't pay any postage charge at all.
This is obviously to do with indicative and druff tariff price. Morningside doesn't have a indicative price available
Morningside does have indicative prices in the dm+d database:
5
dmd-browser.nhsbsa.nhs.uk/a...
10
dmd-browser.nhsbsa.nhs.uk/a...
20
dmd-browser.nhsbsa.nhs.uk/a...
So indicative price is £95, tariff price £62.35
£32.65 difference. Is this what the pharmacist would be out if pocket? If brand written on script do they still lose out?
Just trying to work out why it is virtually impossible to get Morningside.
Do you happen to know what last months indicative price was?They had to check last time that they could supply. I'm worried over my next prescription as it will be for more boxes and scared they won't supply
It has had that price since 01/07/2024!
Before then, there was no such indicative price.
At a guess your GP doesn’t know how to easily change this in your prescription. If they use EMIS Web I can provide a screenshot how they can implement this change quickly for you
Could you post that anyway?
I'm sure it will help someone.
I am having the exact same problem. Been waiting 3 weeks for Advanz to come in but supplier keeps sending Morningside.
I now have no choice but to try Morningside.
Does anyone have an opinion on Morningside?
I can only take Morningside. Mercury pharma was like poison to me We are all different and react to excipients differently.
I have a history with reactions to excipients
My endo said a lot of his patients tolerate Morningside best.
Thanks that is helpful and hopefully will help to allieve the anxiety I am feeling at trying Morningside.
It's just that for 10 years I have been balanced on Advanz/Mercury Pharma and have now settled at a good weight.
The people I know on Morningside do not seem as well as I am.
So yes, concerned.
I understand completely. I ended up purchasing my own t3 after feeling dreadful on Mercury pharma years ago. 10 years I self sourced uni-pharma brand as I was well on it.It became increasingly difficult to source and the cost.
Last year I asked my endo would he prescribe and now happily on Morningside. My first script I was given Mercury pharma and yet again it made me so ill. I was ready to throw towel in but then was able to get Morningside wrote on script.
Now the headache has started all over again with supply but at least it doesn't cost me now. I've spent over 6k on scrambling round the Internet looking for my next couple of months supply ( yes, you feel like a drug addict looking for your next fix)
Sorry, I started rambling on there.
Oh I so understand.
I was for a few years on Cytomel sourced from Mexico till I managed to get a NHS endo to prescribe T3 for me and was lucky that Advanz/MP suited me.
My brother is on Roma brand and doing well. My sister is on Morningside and terrible.
Got to give it a try!
I bet this has been asked before, so apologies!
What do NHS indicative price, and Drug tariff price mean? Why are they different?
Have fun trying to get your head round these things!
I look at it as Drug Tariff price being what the NHS agrees is a reasonable price to pay.
NHS Indicative price is what the supplier (manufacturer/importer/distributor) wants/expects to receive.
The difference is where pharmacies have a major problem.
Medicinal Product Price
Information relating to the price (indicative only) of the actual medicinal product pack.
Price, Date of Price Validity, Price Prior to Change Date
Field Population:
A price in pence, sterling
A date
Additional Information:
An indicative price for the pack will be entered where a price list is available from a supplier.
Where price information is received for products that are used only within secondary care, this will also be taken as the indicative price.
nhsbsa.nhs.uk/sites/default...
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...
Thanks, but it's all gobbledygook it me still. My brain can't process anything these days. 😢
Thank you! I'll work on these sentences you wrote:
I look at it as Drug Tariff price being what the NHS agrees is a reasonable price to pay.
NHS Indicative price is what the supplier (manufacturer/importer/distributor) wants/expects to receive.
The difference is where pharmacies have a major problem.
Are you able to go to a different pharmacy other than Boots? I used to have an issue with them, there was always one item missing from my prescription list. My late dad never got everything on his list so we moved to a different pharmacy and I get everything on my prescription
Hi my local pharmacy refused me outright.
I do know that Mercury has had some changes to its licensing and its Levo is no more & they’ve reverted back to Eltroxin which similarly has to be written into the first line of the script. Ironically it was Boots that explained this to me.
Boots dispense my script.
The GP must write the name of the preferred brand of medication on the script to ensure the same product is dispensed each month.
It's no skin off Boots's nose if they dispense X or Y brand to me. They're not paying for the meds.
Changing a pharmacy is unlikely to solve the problem, if the problem is the brand chopping and changing month to month.
The solution for me was to write an actual letter to the GP asking for the precise name of brand to be on the script.
Once that happened, I've had the correct brand dispensed each month.
interesting all this info on T3. Aug24, my Boots said they only had 2 brands of T3, one manufactured in Ireland costing £26 per tub of 28 tabs the other Morningside £165 same amount!
Boots new policy is to give out the cheapest meds. This Irish one was new so I thought I’d try it, only to find it had mannitol in it, which I’ve had past problems with, and already filled a yellow card out in 2019 to confirm my discussions with 3 pharmacists about my problem.
I’d to return to reception to go through the palaver of doc rewriting my prescription with Morningside on every nook and cranny to suit Boots request so they could claim back the extra expense of this Morningside packet, from the govt.
On returning the Irish Meds to Boots they proceeded to bin it, yet the under lid seal was still in blister condition! I pointed this out and left saying no wonder the NHS is in debt!
Interesting. If indicative price is £95, where have they got the figure £165 and also which Irish manufacturered t3 only cost £26.I wonder if someone was telling porkies to put you off pushing for Morningside? Hopefully helvella will know more.
I know if on a private prescription the going rate is usually the cost of medication plus 50%. Some charge more, some less.
What did you get that was manufactured in Ireland?
I'm aware of Viatris/Sigmapharm - but the price of that is very high - not £26.
Cynomel T3 is made here in France by Sanofi. Back in 2017 the cost was just over 4 euros euros for 30 tablets.
Mine is now free as I have no thyroid.
Doesn't make a scrap of difference, but the nowadays product is actually manufactured by PATHEON FRANCE, 40, CHAMPARET BOULEVARD 38300 BOURGOIN JALLIEU - between Lyon and Grenoble.
OK thanks.
GP not prepared to prescribe a brand of T3
