Drug pricing: petition below updated 7th August 2021
HYDROCORTISONE: more details of the rise and fall in its price.
MSD marketed the drug before 2008 and the BNF price for 30 tablets of 20mg was £1.07. MSD stopped marketing the drug in the UK, and this was taken over by Auden McKenzie, who slowly increased the price until by 2010, the BNF price was £51.25 for exactly the same thing, except that it was listed as “non-proprietary”). Despite widespread publicity in many newspapers, (https://www.dailymail.co.uk/news/article-1295610/NHS-doesnt-care-cost-medicine-Drugs-firms-accused-profiteering-raising-prices-ONE-THOUSAND-cent.html) no action was taken. No other company seemed to be interested in competing with Auden. Because hydrocortisone is essential for survival of many patients, the NHS simply paid the increased cost. Prices in Europe were a lot lower, but it was not legal to import hydrocortisone from Europe, even though the price was substantially lower, because the marketing of all drugs in the UK require a marketing licence from the MHRA (https://www.gov.uk/guidance/contact-mhra) and no company seemed to be interested in obtaining a licence even to market European hydrocortisone.
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In 2015, the BNF price of hydrocortisone had increased to £78.62 and we started investigating different steroids to compare them with hydrocortisone at different strengths. Imperial College commissioned a company in West London (Genesis Pharmaceuticals) to make tablets of hydrocortisone for the research study, “Safety and efficacy of Prednisolone in Adrenal Insufficiency Disease (PRED-AID study) http://www.isrctn.com/ISRCTN41325341.
Further publicity in 2016 in the Times (https://www.mjauk.org/wp-content/uploads/2017/05/B-Kenber-MJA-entry.pdf) also failed to have any impact on the price of hydrocortisone and the price continued to rise annually until in 2017, the price increased further to £147.
Genesis Pharmaceuticals, having synthesised hydrocortisone for our research, then obtained a marketing licence for hydrocortisone, and then began competing. The competing hydrocortisone became available in November 2017, and the price then fell from £147 until by 2021, the price is now £3.55 for a month’s supply.
This evidence shows that competition can work in the pharmaceutical industry, and that it might need to be started by someone commissioning the drug for another reason without profit motive. In our case it was to act as a control group in a research study looking at another steroid, prednisolone: http://www.imperialendo.com/prednisolone.
The mechanism of a university commissioning the drug for research and then also launching it in open competition has clearly worked in the case of hydrocortisone, with the added advantage of there now being several strengths (https://www.genesis-pharma.com/hydrocortisone/) available.
There are many other drugs where price gouging is still occurring. Synacthen cost £2.70 per vial until 2016, but the following year it cost £38 per ampoule. The NHS is now paying the higher price, and many don’t realise this has happened. Liothyronine has increased from £4.46 to £186 for a month’s supply of 20mcg tablets. A similar fate is about to occur with Lithium Carbonate, which has been available as Priadel for many years at £4.02 for 100 tablets at 400mg and is also available as Camcolit for £48.18 for the same quantity.
We need NHS improvement to take over the licence for the manufacture or Priadel, and ensure that production of this version of lithium carbonate does not cease.
Pharmaceutical companies play an important role in the innovation and development of new medicines, protected by patents. It is only a minority of companies that undertake price gouging of generics and we ask that NHS Improvement promotes the safe and efficient manufacture of non-patented medications for use within and by the NHS.
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