CCGs could face fresh pressures to fund costly drug

Liothyronine is prescribed for a small number of patients who do not do well on levothyroxine, the standard treatment for hypothyroidism. But liothyronine’s price has soared in recent years and NHS England has tried to restrict its use.

However, after pressure from patient groups, NHSE will soon issue a third version of its advice, which is expected to make it clear the medication’s use is appropriate in some cases.

Lorraine Williams, director of patient group The Thyroid Trust, said: “We anticipate that clarification of the Regional Medicines Optimisation Committees guidance will mean that more patients who require this treatment will be able to access it in the coming weeks and months.”

The Thyroid Trust believes the restrictions placed on liothyronine prescribing have forced some patients to source the drug privately – both within the UK and from cheaper supplies abroad. “It is beyond ironic that individual patients with chronic health conditions are able to negotiate better prices for this medicine, from suppliers all over the world, than the NHS, with all its buying power, has been able to do so far,” said Ms Williams.

The most recent guidance, which has been in place since last November, suggested liothyronine should only be prescribed in very rare circumstances.

A dossier put together by The Thyroid Trust in October showed many patients were being told the drug could no longer be prescribed, even if they had been taking it with good results, and the patient group said this has continued under the more recent guidance. According to the dossier, few CCGs mention the possibility of “exceptional” funding for the drug.

An NHSE spokesperson confirmed a revision of the existing advice was underway and said: “The NHS provides high-quality care and at the same time must ensure every pound is spent wisely. CCGs should take account of guidance that has been published and offer liothyronine where it is clinically appropriate to do so.”

Julie Wood, chief executive of NHS Clinical Commissioners, said: “Alongside NHSE we produced commissioning guidance on the prescribing of liothyronine and have advised our member CCGs to take note of the specific exceptionalities around the prescribing of liothyronine included in this guidance.

“However, this does not preclude local CCGs from making decisions to restrict prescribing further if they are of the view that this is in the best interests of their local populations.”

The price paid by the NHS for liothyronine tablets increased by 1,605 per cent between January 2009 and July 2017, according to the Competition and Markets Authority. In late 2017, the watchdog alleged Advanz – the sole supplier for several years, which was formerly known as Concordia – had breached competition law by charging excessive and unfair prices. The investigation continues, although there are now more suppliers in the UK.