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1719437

registered interest
date	20/05/2024
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Liothyronine
house id	1
legislature	25259 pref label House of Commons
question text	To ask the Secretary of State for Health and Social Care, what steps her Department is taking to ensure that Liothyronine is acquired by the NHS at the best possible price.
tabling member constituency	Portsmouth South
tabling member printed	Stephen Morgan
uin	27175
answer	answer is ministerial correction date of answer 23/05/2024 answer text <p>Liothyronine is marketed as a generic medicine. For generic medicines, we rely on competition to keep prices down. This works well for the most part, as evidence shows we have amongst the lowest prices in Europe for generic medicines. The system also means we have a relatively resilient supply, as flexibility on pricing allows manufacturers to increase prices where supply on a particular drug is reduced or demand increases, supporting continuity of supply for patients in the United Kingdom.</p><p>Between 2009 and 2017, there was only one supplier of liothyronine, and they were charging a price considered to be excessive and unfair by the Competition and Markets Authority (CMA). Following an investigation which concluded in July 2021, the CMA decided to issue fines totalling £101.4 million against the three undertakings which controlled the supply during this time.</p><p>That decision is currently under appeal before the Court of Appeal, having previously been upheld by the Competition Appeal Tribunal in August 2023. Since 2016, several marketing authorisations have been granted to other suppliers for liothyronine, and its price to the National Health Service has been decreasing as a result of direct competition in the market. The Department has no price comparison information on liothyronine.</p> answering member constituency Pendle answering member printed Andrew Stephenson grouped question UIN 27176 question first answered 23/05/2024 16:45:16 answering member 4044 label Biography information for Andrew Stephenson
tabling member	4653 label Biography information for Stephen Morgan

1719438

registered interest
date	20/05/2024
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Liothyronine
house id	1
legislature	25259 pref label House of Commons
question text	To ask the Secretary of State for Health and Social Care, whether her Department has made a comparative estimate of the cost of Liothyronine in (a) the UK and (b) other countries.
tabling member constituency	Portsmouth South
tabling member printed	Stephen Morgan
uin	27176
answer	answer is ministerial correction date of answer 23/05/2024 answer text <p>Liothyronine is marketed as a generic medicine. For generic medicines, we rely on competition to keep prices down. This works well for the most part, as evidence shows we have amongst the lowest prices in Europe for generic medicines. The system also means we have a relatively resilient supply, as flexibility on pricing allows manufacturers to increase prices where supply on a particular drug is reduced or demand increases, supporting continuity of supply for patients in the United Kingdom.</p><p>Between 2009 and 2017, there was only one supplier of liothyronine, and they were charging a price considered to be excessive and unfair by the Competition and Markets Authority (CMA). Following an investigation which concluded in July 2021, the CMA decided to issue fines totalling £101.4 million against the three undertakings which controlled the supply during this time.</p><p>That decision is currently under appeal before the Court of Appeal, having previously been upheld by the Competition Appeal Tribunal in August 2023. Since 2016, several marketing authorisations have been granted to other suppliers for liothyronine, and its price to the National Health Service has been decreasing as a result of direct competition in the market. The Department has no price comparison information on liothyronine.</p> answering member constituency Pendle answering member printed Andrew Stephenson grouped question UIN 27175 question first answered 23/05/2024 16:45:16 answering member 4044 label Biography information for Andrew Stephenson
tabling member	4653 label Biography information for Stephen Morgan

1581667

registered interest
date	30/01/2023
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Liothyronine
house id	2
legislature	25277 pref label House of Lords
question text	To ask His Majesty's Government what cost assessment they have undertaken of the daily dose rationing of liothyronine regardless of clinical need by the (1) NHS Devon, (2) NHS Buckinghamshire, and (3) NHS Hertfordshire, Integrated Care Boards; and what comparative assessment they have made of (a) the NHS England national guidance, and (b) the National Institute for Health and Care Excellence British National Formulary guidance on liothyronine, given the risk of harm to patients and that smaller doses lead to higher costs.
tabling member printed	Lord Hunt of Kings Heath
uin	HL5206
answer	answer is ministerial correction date of answer 09/02/2023 answer text <p>No assessments have been made.</p> answering member printed Lord Markham question first answered 09/02/2023 12:17:34 answering member 4948 label Biography information for Lord Markham
tabling member	2024 label Biography information for Lord Hunt of Kings Heath

1564250

registered interest
date	06/01/2023
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Liothyronine
house id	1
legislature	25259 pref label House of Commons
question text	To ask the Secretary of State for Health and Social Care, what assessment his Department has made of the potential merits of expanding access to the drug Liothyronine T3 for people with hypothyroidism.
tabling member constituency	Bristol North West
tabling member printed	Darren Jones
uin	117833
answer	answer is ministerial correction date of answer 16/01/2023 answer text <p><strong> </strong>No specific assessment has been made. Decisions about prescribing rest with the healthcare professional concerned, who has clinical responsibility for that particular aspect of a patient’s care. Prescribing is informed by a range of factors, including any national or local prescribing guidelines but, ultimately, the decision on what to prescribe is made by the prescriber themselves, using their own clinical judgement.</p><p>NHS England’s guidance ‘Items which should not be routinely prescribed in primary care’ states that levothyroxine is the first line treatment for hypothyroidism and liothyronine should not be routinely prescribed. However, the guidance states that liothyronine may be recommended for individual patients who may not respond to levothyroxine alone. This guidance has been refreshed and stakeholder feedback on proposed changes were considered in the summer.</p><p>Guidance on the prescribing of liothyronine has also been published by the Regional Medicines Optimisation Committee and this is being updated at a national level. The Department understands this will state that it is appropriate to prescribe liothyronine for some patients and sets out how prescribers may determine this, and that only patients who have not previously been reviewed should be reviewed to consider future treatment plans. This document is still being drafted and further refined following stakeholder engagement.</p> answering member constituency Colchester answering member printed Will Quince question first answered 16/01/2023 13:26:33 answering member 4423 label Biography information for Will Quince
tabling member	4621 label Biography information for Darren Jones

1536839

registered interest
date	27/10/2022
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Liothyronine
house id	1
legislature	25259 pref label House of Commons
question text	To ask the Secretary of State for Health and Social Care, What steps he has taken to improve access to Liothyronine (T3) for the treatment of hypothyroidism?
tabling member constituency	Tiverton and Honiton
tabling member printed	Richard Foord
uin	73171
answer	answer is ministerial correction date of answer 08/11/2022 answer text <p>No specific assessment has been made. NHS England’s guidance ‘Items which should not be routinely prescribed in primary care’ states that levothyroxine is the first treatment for hypothyroidism and liothyronine should not be routinely prescribed. However, the guidance states that liothyronine may be recommended for individual patients who may not respond to levothyroxine alone. NHS England is currently reviewing its guidance and has engaged with patient groups and other stakeholders to obtain feedback.</p> answering member constituency Colchester answering member printed Will Quince question first answered 08/11/2022 16:58:11 answering member 4423 label Biography information for Will Quince
tabling member	4942 label Biography information for Richard Foord

1453380

registered interest
date	22/03/2022
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Liothyronine
house id	1
legislature	25259 pref label House of Commons
question text	To ask the Secretary of State for Health and Social Care, whether he has had discussions with relevant stakeholders on reviewing prescription guidelines following the decision by the Competition and Markets Authority to fine Advanz for the inflation of the price of Liothyronine.
tabling member constituency	Ellesmere Port and Neston
tabling member printed	Justin Madders
uin	144938
answer	answer is ministerial correction date of answer 13/04/2022 answer text <p>We have met with representatives from the Thyroid Trust and Thyroid UK to discuss prescription guidelines relating to Liothyronine.</p> answering member constituency Charnwood answering member printed Edward Argar question first answered 13/04/2022 10:05:05 answering member 4362 label Biography information for Edward Argar
tabling member	4418 label Biography information for Justin Madders

1361539

registered interest
date	19/10/2021
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Liothyronine
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government what steps NHS Clinical Commissioners took to communicate national guidance for the prescribing of liothyronine to local NHS bodies; and whether that guidance says that liothyronine may only be prescribed when recommended by a specialist after treatment using levothyroxine has failed.
tabling member printed	Lord Hunt of Kings Heath
uin	HL3197
answer	answer is ministerial correction date of answer 29/10/2021 answer text <p>National Health Service clinical commissioners have promoted national guidance through their bulletins with clinical commissioning groups members. National guidance recommends that in circumstances where levothyroxine has failed, endocrinologists providing NHS services may recommend liothyronine for individual patients after a carefully audited trial of liothyronine for at least three months duration.</p><p>We have made no assessment on whether liothyronine should be de-classified as a high cost medicine. To date, NHS England NHS Improvement have not conducted any specific assessments on liothyronine following the Competition and Markets Authority ruling. This will be considered as part of any formal review to national guidance.</p> answering member printed Lord Kamall grouped question UIN HL3198 question first answered 29/10/2021 09:52:10 answering member 4909 label Biography information for Lord Kamall
tabling member	2024 label Biography information for Lord Hunt of Kings Heath

1361540

registered interest
date	19/10/2021
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Liothyronine
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government what assessment they have made of whether liothyronine should be declassified as a high-cost medicine following the Competition and Markets Authority ruling and fine issued to Advanz for artificially inflating the price of thyroid tablets.
tabling member printed	Lord Hunt of Kings Heath
uin	HL3198
answer	answer is ministerial correction date of answer 29/10/2021 answer text <p>National Health Service clinical commissioners have promoted national guidance through their bulletins with clinical commissioning groups members. National guidance recommends that in circumstances where levothyroxine has failed, endocrinologists providing NHS services may recommend liothyronine for individual patients after a carefully audited trial of liothyronine for at least three months duration.</p><p>We have made no assessment on whether liothyronine should be de-classified as a high cost medicine. To date, NHS England NHS Improvement have not conducted any specific assessments on liothyronine following the Competition and Markets Authority ruling. This will be considered as part of any formal review to national guidance.</p> answering member printed Lord Kamall grouped question UIN HL3197 question first answered 29/10/2021 09:52:10 answering member 4909 label Biography information for Lord Kamall
tabling member	2024 label Biography information for Lord Hunt of Kings Heath

1361541

registered interest
date	19/10/2021
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Liothyronine
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government whether they will conduct a review of (1) the actions of NHS England, and (2) the impact on patients with thyroid conditions, following the Competition and Markets Authority’s ruling and fine issued to Advanz for artificially inflating the price of thyroid tablets.
tabling member printed	Lord Hunt of Kings Heath
uin	HL3199
answer	answer is ministerial correction date of answer 29/10/2021 answer text <p>We have no plans to do so. NHS England and NHS Improvement’s guidance Items which should not routinely be prescribed in primary care: Guidance for CCGs identifies items which are clinically effective but where more cost-effective products are available. This includes liothyronine and other products that have been subject to excessive price inflation.</p><p>The guidance states that there are three categories for such items which are as follows:</p><p>- Products of low clinical effectiveness, where there is a lack of robust evidence of clinical effectiveness or there are significant safety concerns;</p><p>- Products which are clinically effective but where more cost-effective products are available, including some products that have been subject to excessive price inflation; and</p><p>- Products which are clinically effective but due to the nature of the product are deemed a low priority for National Health Service funding.</p><p> </p><p>Liothyronine was included in the second category. Additionally, it was noted that there was limited evidence to support its routine prescribing in preference to levothyroxine. A copy of this guidance is attached. NHS England and NHS Improvement will review the guidance on a regular basis to ensure that any updated evidence on clinical and cost effectiveness is considered.</p> answering member printed Lord Kamall question first answered 29/10/2021 09:55:14 answering member 4909 label Biography information for Lord Kamall attachment 1 file name HL3199 - Attachment 2.pdf title Items which should not routinely be prescribed in
tabling member	2024 label Biography information for Lord Hunt of Kings Heath

1360890

registered interest
date	18/10/2021
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Liothyronine
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government, further to the Written Answer by Lord Bethell on 17 March (HL14040), what assessment they have made as to whether the fall in the price of Liothyronine (T3) is related to increased competition from marketing authorisations granted since 2016.
tabling member printed	Lord Hunt of Kings Heath
uin	HL3158
answer	answer is ministerial correction date of answer 22/10/2021 answer text <p>We have made no further assessment of the price of Liothyronine relative to increased competition from marketing authorisations or the cost of medicines in other parts of Europe. Further marketing authorisation applications remain at the discretion of pharmaceutical companies.</p> answering member printed Lord Kamall grouped question UIN HL3159 HL3160 question first answered 22/10/2021 10:19:03 answering member 4909 label Biography information for Lord Kamall
tabling member	2024 label Biography information for Lord Hunt of Kings Heath