Problem getting Morningside Liothyronine on NHS

[notatortoise]

I have been on Morningside Liothyronine for 4 years. This has been the most consistent brand for me. I've tried others and all have had nasty side effects.

Up until now my local pharmacy have been very helpful in obtaining the brand. However, there appears to have been a supply issue over the last few months. I have been getting mixed reasons as to why there have been issues until today. The local pharmacy called to advise that they were unable to obtain or supply the Morningside brand due to cost. The cost to the pharmacy is £165 per pack, and as there are alternative cheaper suppliers the pharmacy are unable to prescribe the brand as the NHS are not prepared to pay back that amount.

I've read the NICE guidelines on Levothyroxine supply, and these state that ' If persistent symptoms are reported when switching between different formulations, consider consistently prescribing a specific product known to be well tolerated by the person'

Is it possible to insist on a specific product, even though the pharmacy may not be fully reimbursed? I've offered to pay the price differential, but they say that as I am an NHS patient that it would need to be a private prescription.

Has anyone else had issues obtaining Morningside Liothyronine recently, and what was the outcome? Any tips on how to obtain the product consistently would be very much appreciated.

[Regenallotment Ambassador]

This is so frustrating isn’t it. helvella might have an update on availability.

Certainly the GP can name it for you on the prescription. My understanding is if the GP names it in the top line then the pharmacy can recoup costs (but that’s what I’ve heard not concrete fact - Helvella will know for sure).

[helvella in reply to Regenallotment]

Sorry - I have no other information on availability.

Appendix F has How to write prescriptions:

helvella - Thyroid Hormone Medicines - UK

The UK document contains up-to-date versions of the Summary Matrixes for levothyroxine tablets, oral solutions and liothyronine available in the UK. Includes injectables and descriptions of tablet markings which allow identification. Latest updates include all declared ingredients for all UK-licensed products and links to Patient Information Leaflets, Dictionary of Medicines and Devices (dm+d), British National Formulary, NHS Drug Tariff, etc. PLUS how to write prescriptions in Appendix F.

Also includes links for anti-thyroid medicines (but not product details).

📄 dropbox.com/s/bo2jzxucgp9hl...

[notatortoise in reply to helvella]

Thank you Helvella.

My understanding from today's conversation is that there are no availability issues. The issue is purely cost driven. I will ask the pharmacist in the surgery if the GP can write a brand specific prescription. I thought they were already doing that, which is why I always get the Morningside brand, but I'll double check if this is the case. Do you have a breakdown of current prices for all brands of Liothyronine? I've tried searching NHS site, but find it very difficult to navigate.

[helvella in reply to notatortoise]

My medicines document has links to the dm+d - that is the most up to date pricing. Other places like the NHS Drug Tariff do not have the specific prices by manufacturer.

E.g. 20 microgram Morningside Liothyronine is here: dmd-browser.nhsbsa.nhs.uk/a...

Price 9500 (£95.00) for 28.

[notatortoise in reply to Regenallotment]

Thank you. My understanding is that the GP pharmacist is specifying Morningside, but there appears to be an issue with the pharmacy being able to recoup the differential. I'll keep pushing for a positive result, it's just frustrating to have to fight to stay healthy.

[Regenallotment Ambassador in reply to notatortoise]

hmmm I would contact MP to ask why when patients follow Gov's own advice they are struggling to get this via the pharmacy. I had good results that way, although 8 months later I was back round again as I couldn't get my preferred T4, but that was resolved with some tenacity, I rang the supplier.

I found this info about Morningside with a quick google, I would call them and ask their advice too. It helps to understand it from all angles.

medicines.org.uk/emc/produc...

[helvella in reply to Regenallotment]

Morningside 20 microgram on dm+d.

Screenshot of dm+d

[Regenallotment Ambassador in reply to helvella]

Is that 2024 end date telling us they are no longer available?

[helvella in reply to Regenallotment]

No - the 9500 price started on 01/07/2024. And the previous price was terminated - but I do not know why it is shown as zero.

[notatortoise in reply to helvella]

So that’s a huge increase since July if the pharmacy are paying £165 per pack

[helvella in reply to notatortoise]

This is the problem. The NHS price is not the distributor's price but it ends up meaning pharmacies cannot supply and make that sort of loss.

[notatortoise in reply to helvella]

Just so I can understand the issue. The NHS price that they are prepared to pay is £95, but the pharmacy are buying from a distributer at £165, thus they have a shortfall of £70 ie no profit. So they are unwilling to dispense, and if the GP specifies the Morningside brand will the NHS pay the full amount to the pharmacy?

[helvella in reply to notatortoise]

Something like that - but I'm not sure that the NHS would ever pay the full price. The NHS Drug Tariff price for 20 microgram liothyronine is £75.92. But that is because it is Category A:

2.1 Category A - Drugs which are readily available as licensed generic medicines. Broken Bulk may be claimed for those products whose smallest pack size has a price greater than or equal to £50, if necessary.

This is why it is so difficult to understand and address the issues.

Liothyronine 20microgram tablets 28 7592 PPA Symbol K A

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

[notatortoise in reply to helvella]

Thank you. I don’t know how to send a screen shot, but have managed to get into the NHS suppliers part of the site, and under the 20 mcg section there’s a red tick beside the Morningside brand under the heading discontinued.

[helvella in reply to notatortoise]

I think you are getting misled by what it says!

The product used to be available as branded product - Iraksin. It is that which has been discontinued. Just over halfway down is Morningside as generic liothyronine.

I assure I still feel incredibly ignorant despite trying to get my head round things for years!

Screenshot of 20microgram liothyronine tablet suppliers.

[notatortoise in reply to helvella]

Thank you for all your help, it is very much appreciated. I feel more informed and knowledgeable now to pursue a solution 🤞for a positive outcome. It just shouldn't have to be this way that we have to constantly fight for something that gives us good health.

[helvella in reply to notatortoise]

If you find I have misinformed you - or confused - please have no hesitation in letting me know.

[notatortoise in reply to Regenallotment]

Thank you very much for all your support and advice. I will call Morningside. I did this with Wockhardt a few years ago when the pharmacy told me that there were supply issues with that brand, and there were no issues. MP great advice as they really should be interested to know what’s going on in the NHS if they truly are looking to reform.