Pharma firm fined over pricing of crucial thyroid drug and ripping off the NHS

The CMA has imposed over £100 million in fines after Advanz inflated the price of thyroid tablets, causing the NHS and patients to lose out.

Following an investigation, the Competition and Markets Authority (CMA) has found that from 2009 until 2017 the pharmaceutical company Advanz charged the NHS excessive and unfair prices for supplying liothyronine tablets which are used to treat thyroid hormone deficiency.

They achieved this because liothyronine tablets were among a number of drugs that, although genericised, faced limited or no competition and therefore could sustain repeated price increases. This strategy, which began in 2007, involved an overall price increase for liothyronine tablets of more than 6,000 per cent.

The CMA has fined the firms involved a total of over £100 million for the relevant periods in which they broke the law. Advanz fined was £40.9 million, together with HgCapital, £8.6 million, and Cinven, £51.9 million – two private equity firms which were previously owners of the businesses now forming part of Advanz.

The thyroid drug’s 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.

“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,” said Andrea Coscelli, Chief Executive of the CMA, on July 29.

“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.

The investigation into these firms is part of the CMA’s ongoing work in the pharmaceutical sector. Recent action includes securing an £8 million repayment to the NHS after companies took part in illegal arrangements relating to the supply of fludrocortisone, and fining firms £260 million for competition law breaches in relation to the supply of hydrocortisone tablets.

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