Global thyroid pharma economics: T3 meds

Thyroid pharma economics

Thyroid pharma economics-CAD

Here’s an update on prices in some locations of the world, and Canada, for synthetic T3 medication, known by the chemical name liothyroinine.

UNITED KINGDOM & GREECE

A Daily Mail article published May 27, 2019 reported the prices for T3 / Liothyronine pills in the UK over time, and today in Greece:

20-25 mcg / day, 1 month

  • UK, 2007, 28 x 20 mcg = £4.46 GBP  = $ 7.61 CAD
  • UK, 2019, 28 x 20 mcg = £204.39 GBP = $348.77 CAD
  • GREECE, 2019, 30 x 25 mcg = £1 GBP = $1.71 CAD

Quotations from the article:

“Going on holiday to Greece is no longer just about soaking up the sunshine for Mary Saunders — it’s her lifeline.

The 63-year-old spends much of the trip with her husband Garry, 64, travelling from one pharmacy to another buying a thyroid drug that should be available on the NHS. It helps her avoid the crippling fatigue, weight gain and depression caused by her underactive thyroid, or hypothyroidism.

But after its maker used a loophole to inflate the price by 4,600 per cent over ten years, some local health authorities have stopped prescribing liothyronine for hypothyroidism. Priced at £204.39 for a 28-day course compared to just £4.46 in 2007, the only alternative is to obtain tablets by private prescription.

That is is out of the question for many patients, including Mary, as it is too expensive. Instead she stocks up in Greece, where a packet of 30 of the 25mg tablets costs just £1.

‘It’s a terrible situation,’ says Mary, from Peacehaven, East Sussex, who was diagnosed with hypothyroidism 11 years ago. ‘But I don’t have a choice. Last time I was able to bring back a 15-month supply.’” […read more at Daily Mail]

CANADA & MEXICO

And here’s where we are at in Canada:

  • CANADA, Cytomel, 30 x 25 mcg = $53.70 CAD = £31.47 GBP
  • MEXICO, Cynomel, 30 x 25 mcg = $4.09 CAD = £2.40 GBP = $57.90 MXN

BUT in Canada at the moment, there is a shortage on the 25mcg pills. “Disruption of the manufacture of the drug.” Estimated availability reported on drugshortagescanada.ca is now July 2019. It’s been on shortage since about February 2015.

You can still buy the 5 microgram pills. However, filling the same prescription in 5-microgram pills (Canadian Pharmacy King) would cost you a lot more per microgram:

  • CANADA, Cytomel, 150 x 5 mcg = $223.50 CAD

Don’t you think it very strange that the 5 mcg pills by the same company cost 4.16x more per microgram?

Doesn’t that sound like it’s taking advantage of the higher number of people who order the 5mcg pills?

During the shortage, I became resourceful. I asked other thyroid patients on support forums. One suggested I call Pfizer.

After phoning the Pfizer support line, I learned that they were willing to make a deal with my pharmacy and give me the 5mcg pills at the same price as what it would cost in 25mcg pills, if the pharmacy called them at a special phone number and extension.

Now that’s just unfair to all the patients paying 4.16x more for 5mcg pills during the 25mcg pill shortage, and the shortage has been extended — it used to end in June, now it’s ending in July.

Luckily I found a better alternative, again through the thyroid patients support network.

I was able to get compounded T3 liothyronine powder in capsules from Calgary Create Compounding Pharmacy. I have ordered 15mcg capsules to customize my doses, so here’s the price for almost the equivalent, 30 mcg/day for 1 month:

  • CANADA, Liothyronine powder, compounded, 60 x 15 mcg = $18 CAD

Yes it works fine, but I find I absorb it differently from Cytomel, so it took a little adjustment.

CHALLENGES FOR CANADIAN CITIZENS

Of course, it all depends on A) where you live, B) whether you can travel to buy your meds, and C_ what your insurance plan(s) will cover (if you choose compounded, ask first!).

This makes it very challenging to afford being on the thyroid medication that you need, if your body needs T3, like mine does.

The biggest challenge is not having security about the future.

When will the next shortage be?

When will the next price increase be?

Why does it cost so much more $$ to synthesize a thyroid hormone molecule with 3 iodine atoms, when they manufacture the one with 4 iodine atoms in abundance and sell it cheaply? (Levothyroxine, Synthroid, Eltroxin)

PubChem-thyroxine-liothyronine

Manufacturers can’t tell us that they are running out of raw material.

What do they make thyroid hormones out of? Vegetable matter.

Oh no, we’re running out of veggies? Seriously?

No, it’s because of a clear choice to have a “disruption in manufacturing” of liothyronine molecules at this time. It fits with the business plan.

There’s no competition in Canada. It’s just Pfizer’s Cytomel. The compounding pharmacies get their powder from a wholesaler who likely gets it from the US.

TRAVELLING TO BUY MEDS

As for buying your medication from another country, Canadian law does NOT permit mail-ordering anything sold as a prescription in Canada. See what FedEx says about “Prescription Drugs for Personal Use.”

However, you can travel back to Canada with 90 days’ supply with you. You need to have a prescription saying how much you need per day, otherwise they don’t know how much is 90 days’ supply for you. Check the policies on the Government of Canada website before you try.

ANTI-T3 IDEOLOGY

Consider the injustice of this pharmaceutical situation.

At least 95% of the world’s citizens with healthy thyroid glands get a continual infusion of T3 hormone injected into bloodstream.

In other words, most people walk around with a built-in T3 hormone pharmacy in their neck. They don’t pay a penny.

Healthy-thyroid citizens are “shooting up” T3 directly into their bloodstream, every hour of every day.

For FREE.

The average person can get more T3 out of their gland whenever their body asks for it, simply by stimulating that gland more by sending out more TSH hormone (thyroid stimulating hormone). To the degree the gland is stimulated by TSH, it increases its T3 output more than its T4 output, according to thyroid science.

At least 20% if not 30% of a human’s T3 supply comes from a healthy thyroid gland, and the exact ratio is variable– that’s a point that I’m currently exploring in my T3:T4 ratio series on this blog.

But we, the thyroid-disabled citizens, are supposed to be just fine without 20-30% of our body’s T3 supply.  We can only get this vital hormone from synthetic liothyronine or desiccated thyroid medication, OR by converting our T4 meds. But that’s the problem –some of us thyroid patients are truly “poor converters” of T4 hormone and have difficulty getting enough T3 out of the standard T4 drugs alone — read Midgley et al, 2015.

Therefore, thyroid patients are not routinely told that this Health Canada approved medication, Cytomel, is even available. It might make thyroid patients ask for it, and that would be annoying. And that would compromise the T4 hormone’s monopoly over thyroid therapy.

If a thyroid patient becomes educated about T3 therapy, they have to become a self-advocate.

The thyroid patient first has to fight against anti-T3-testing policies that forbid doctors from finding out if they are low in T3 hormone, because a $10 Free T3 test is now too much to pay for a thyroid patient’s health. No, they must only be tested for TSH, which costs a few pennies more per test!

The Free T3 test is now falsely deemed an “unnecessary” test, even though thyroid science has proven conclusively that the TSH cannot tell the doctor if any organs beyond the pituitary and hypothalamus have enough T3 supply! See my earlier post “The blindness of TSH to the most powerful thyroid hormone.“)

Then, if the patient somehow wins access to a forbidden Free T3 test, they often need to become educated by other patients about how to interpret their own Free T3 lab results (because doctors are not trained to calculate a Free T3:T4 ratio and understand its health implications).

If low T3 is causing the patient’s problems, she then has to beg, plead, cajole, and sometimes go through many doctors to find one willing to prescribe T3 against all the prohibitions against this supposedly “dangerous” yet absolutely essential hormone. Meanwhile, the self-advocating patient is handicapped by fatigue and brain-fog due to low T3.

To top it all off, after leaping through ten rings of fire while being weighed down with a ball and chain on her leg, the patient then pays through the nose to obtain access to this vital hormone.

HELP WITH RESEARCH?

I’d like to do a post on price comparisons for desiccated thyroid (NDT), but I need others to do the work of gathering the stats calculated per month on a lower dose (since people take many doses).

I’m also looking to compare Canadian provincial policies and plans for thyroid hormone drug coverage. With links please. I simply do not have the time to gather the data.

Put them in comments or email them to me, and I’ll use the info to build a future post, eventually.

REFERENCES

Ellis, R. (2019, May 28). How can firms justify the drug daylight robbery? Retrieved May 29, 2019, from Mail Online website: https://www.dailymail.co.uk/health/article-7076005/In-Greece-thyroid-pill-costs-1-month-firms-justify-drug-daylight-robbery.html

Canada pharmacy king: Cytomel https://www.canadianpharmacyking.com/Drug/Cytomel

Canada drug shortages: Cytomel 25mcg https://www.drugshortagescanada.ca/shortage/42172

San pablo farmacia, Ciudad de México, CDMX, Mexico, Cynomel https://www.farmaciasanpablo.com.mx/medicamentos/supervision-medica/a—b—c/cynomel-100-tabletas-frasco/p/000000000006870024

Create Pharmacy and Compounding, Calgary, AB, Canada https://createpharmacy.ca/

FedEx Prescription Drugs for Personal Use Reminder:  https://www.fedex.com/en-ca/shipping-services/international/regulatory/prescription-reminder.html

Travelling with medication, Government of Canada https://travel.gc.ca/travelling/health-safety/medication

Midgley, J. E. M., Larisch, R., Dietrich, J. W., & Hoermann, R. (2015). Variation in the biochemical response to l-thyroxine therapy and relationship with peripheral thyroid hormone conversion efficiency. Endocrine Connections, 4(4), 196–205. https://doi.org/10.1530/EC-15-0056

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