Company officials at RLC Laboratories, the manufacturer of the natural desiccated thyroid drug Nature-Throid, have confirmed that mail order pharmacy Medco Health did not contact RLC prior to Medco's issuing a misleading thyroid drug shortage notice to doctors.
Medco's notice (see PDF), titled "Thyroid Products Shortage," reported a nationwide shortage of all natural desiccated thyroid drugs, and urged doctors to switch their patients to levothyroxine.
The fact is, Medco never contacted RLC prior to issuing their statement. There was a shortage of Armour Thyroid, but not a "nationwide shortage."
Again, it raises the question: Given that natural desiccated thyroid drugs are available, what possible motivation and explanation could there be for Medco to mislead doctors by stating that natural desiccated thyroid is totally unavailable for patients, and push patients toward levothyroxine medications?
Unfortunately, it's not hard to speculate on Medco's motivation, given their questionable track record. Back in 2004, Medco paid more than $29 million to settle a case, brought against them by 20 different states, accusing the mail order pharmacy of "drug-switching" practices. The company was accused of hiking prices, switching prescriptions to favor particular medications, and, according to news reports, "encouraging doctors to switch patients to various prescription drugs by implying that the switch would benefit patients and their plans when in fact, the switch only benefited Medco."
In 2006, Medco agreed to pay another $155 million to settle federal fraud charges that, according to the American Society of Health-System Pharmacists, charged Medco with "destroying and canceling valid patient prescriptions, soliciting kickbacks from pharmaceutical manufacturers to favor their drugs, and paying kickbacks to health plans to obtain business." At that time, Medco was also apparently contacting physicians about switching patients' medications, but were not disclosing to prescribing physicians and patients that Medco would financially benefit from the changes in prescriptions.
The question thyroid patients need to ask now, is, is Medco back to their old tricks, and this time, thyroid patients are the ones suffering?
My advice to consumers who are saddled with Medco as your mail order pharmacy: if you want your Nature-Throid prescription filled, you may have to do so out of pocket. Take your prescription to a pharmacy that wants your business, and isn't trying to tell you and your doctor what thyroid medication to take.
If you don't have a pharmacy in your area that can/will order Nature-Throid for you, you can have your prescription called in or faxed to a pharmacy that will fill your prescription. One such pharmacy that has a supply of Nature-Throid is Knowles Apothecary, in Kensington, MD. Phone: 301-942-7979, Fax: 301-942-5544. (Important Update: As of Sept 9, 2009, Knowles is no longer able to fill orders for natural desiccated thyroid, due to the product shortage. )
And whether it's thyroid medication, or any other medication, you'll want to take About.com Patient Advocacy Guide Trisha Torrey's advice in her article about the Medco scandal, titled "When Pharmacies Play Doctor for Profit." According to Trisha:
"...if you have been taking any medication for a period of time and it has worked for you, and then next time you contact your doctor to ask for a refill prescription, if your doctor tells you it's time to make a switch, then begin asking questions. Two possibilities: First -- it could be that your doctor has been "warned" about a bogus shortage. Or second -- it could be that your doctor is being rewarded by a pharmaceutical manufacturer for writing enough prescriptions of whatever that drug is.
As for the Medco thyroid scandal, if you are a Medco customer, you can complain directly to the company online or by telephone.
You should also submit complaints about Medco to your state's Board of Pharmacies. You can find a list of state pharmacy boards at National Association of Boards of Pharmacy website (click the lower left-hand column under Boards of Pharmacy for a US listing).
Be sure to copy your complaint about Medco to the Department of Health and Human Services Office of Inspector General (Email: HHSTips@oig.hhs.gov, Mail: Office of Inspector General, Department of Health and Human Services, PO Box 23489, Washington, DC 20026) and the Inspector General of the Office of Personnel Management (Email: OIGHotline@opm.gov, Mail: Inspector General, U.S. Office of Personnel Management 1900 E Street NW, Washington, DC 20415).
Photos: clipart.com
It makes me wonder if they sent something out to the doctors about dessicated thyroid in general. My pharmacy only has 90 mg Armour Thyroid on hand so I had to get 60 mg. When they called my doctor to get refill authorization, his nurse called me and said the dosing was getting too confusing and he wanted me to go back on Synthroid. I told her emphatically NO, but I bet when I try next month I have the same problem.
I was diagnosed with hypothyroidism in 1996. I have been using Armour Thyroid since 1998. Like everyone else, I was told that Armour Tyroid is no longer available when I tried to get a refill last week.
I thought after reading Mary’s article on how to get your pharmacy to link with RLC and getting my doctor to change my prescription to Westhroid, that my troubles were over. Wrong. My doctor’s office called in my prescription for Westhroid to my pharmacy (a chain–CVS) this AM. I called this afternoon to see if they were ordering it. They told me that they were unable to get Westhroid either. I tried to give them the phone # of RLC, and they refused to take it. They said they could only order a medication through their one supplier, and that supplier had said the medication was unavailable. They said that even if there were another supplier for Westhroid, that they would not have a way of paying for it. So…it sounds to me like the suppliers have been bought off! Was it Medco?
Tomorrow I am going to call RLC and see if I can find out a pharmacy here in California that uses a supplier that can/does get Westhroid. If I have no luck I will order the Westhroid from the pharmacy in Maryland.
Any other suggestions? What does everyone else do? I have now been out of dessicated thyroid for 5 days….
I live in Southern California. I ran into the same problem. If you find a supplier please let me know. I have exhausted, Rite-Aid, Wal-greens, Wal-Mart, Costco, Target and other independent pharmacies. If you find an in please get it out there for us to see. Thanks.
For Paula, (above), the pharmacies you have listed are not independents. They are big chains. Medicine Shoppe and Leader are Franchises that are independent pharmacies. Google “Leader Pharmacies” and “Medicine Shoppe Pharmacies”, and you should be able to find a page that helps you locate these pharmacies in your area. I think you will have a better chance of getting what you need from these pharmacies because individual Pharmacists own them, and they have control over their own stores.
I found my Naturethroid at a local Compounding Pharmacy. Just a suggestion—there are 2 big Compounding Pharmacies in Madison, WI which “might” carry natural thyroid meds. “Madison Pharmacy Associates” 1-800-558-7046 (which I dealt with years ago for hormonal problems)……and “Women’s International Pharmacy” 1-800-279-5708. I have no idea if they carry our thyroid meds, but it might be something to check out.
For ellenr319 and others in Northern Calif, I found RLC’s products (Nature-Throid and Westhroid) available in stock at Pharmaca and at Sorci Healthcare Pharmacy
When Armour changed it’s “recipe” and screwed me all up, my endo changed me to Naturethyroid. I get it at WalMart and they had to order it for me but I got it the next day.
OK here is what I just learned
Armour (Forest) said all they are changing is to decrease dextrose and increase cellulose, nothing else has changed, thats the added cellulose on your tongue…just swish mouth with water…they have not altered the dessicated thyroid in any way there is absolutely no change in potency..being in medicine it appears to me they are merely controlling sugar levels for diabetics etc..
in addition there is a real problem with their supplier, it has not been worked out yet
you can thank your present GOV for that..I talked with a regional pharmacy chain director who said that FDA has also made a recommendation for a generic during the Armour crisis. This is disturbing at the least. It appears several sources are using this to make it appear there needs to be GOV intervention and with Medco Pharm intervention (that could be interpretted by GOV to need GOV intervention to supercede other company intervention) DO YOU SEE WHAT IS HAPPENING HERE!!!!!
Forest Labs uses a well-tested swine source
they have 120,240,300 mg doses available now..pharmacy needs to call for drop shipment 800-678-1605 ex 66298
I recently switched from Levoxyl/Cytomel (T4 + T3) to Nature-throid. My doctor called the prescription into University Compounding Pharmacy in San Diego (they can mail it or I can pick it up). I feel much better on Nature-throid; little-to-no “afternoon slump” now.
My insurance “co-pay” for Nature-throid was higher than the cost of paying for the Rx out-of-pocket (what’s up with that?!), so I didn’t bother with the insurance. The combined co-pays for both Levoxyl and Cytomel were higher than the cost of the single Rx for Nature-throid, so I’m saving money in the long run.
I also checked with the local independent pharmacy that I usually use (not a corporate chain; it is pharmacist-owned). He said he’d try to order Nature-throid for me, too, if I wanted to transfer my Rx. I try to give my business to independent pharmacies instead of corporate chains. I think they provide better customer service (definitely faster!) and supporting the independent local businesses keeps the local economy stronger (spending your dollars with corporate chains drains money out of the local economy).
I was diagnosed as hypothyroid just over a year ago. After arguing and arguing with my doctor I finally got him to prescribe Armour instead of Synthroid and filled it with no problem right before this alleged “shortage”. I had tried to get him to prescribe Nature-Throid or Westhroid, but he said (through his nurse) that these drugs were not prescription. I ordered Nature-Throid online without a prescription through inhousepharmacy.com and got it in less than two weeks. Since it is coming from Vanuatu I was prepared to wait 3 to 4 weeks so I was happily surprised to get it so quickly. It was relatively inexpensive, about $32 for 100 tablets. The manufacturer is RLC labs and the expiration date is 2012. I haven’t tried it yet since I still have Armour, but I will soon. I would be interested to know if anyone out there is using the RLC products.
The Delta Pharmacy located at 407 Main Street Rio Vista, CA Tel: (707) 374-5135
FAX: (707) 374-5408 always has my prescription. The Doctor faxes them and the order is filled. I have always gotten my Armour Thyroid and recently tried Westroid as prescribed. They are simply marvelous. For those having trouble, do contact them.
Response to Kathy Omeal
Right on, Kathy. Recently I had read that Obama has a Doctor on Board in the FDA who considers Levothyroxin the only appropriate treatment. I believe he is an advocate of the British System. Given too Obama’s relationship with Big Pharma, they want to mandate what we will buy ~ Doctors & Patients are not of any concern, only their show of power is!
I’ve been on Armour Thyroid for a number of years. The last year or so, I haven’t been feeling well, but the test all show O.K. In May I had a melt-down (after a new script). I read your articles, and switched to Nature-Throid. After about 10 days am feeling much better. My local pharmacist can supply me, but the mail-order that I usually use won’t have any Nature-Throid until “mid-September”. Not sure what’s going on, but I sure don’t like pharmacies deciding what works best for me!! And, is there a problem with supply for Nature-Throid?
Kathy,
While you are correct about what changed with Armour, there is a difference in its efficacy for some patients. While taking the new formulation over a three week period, I noticed my old hypo symptoms creeping back. My MD switched me to NatureThroid at my request, which I obtained from a compounding pharmacy – 225 pills for $29.95 – and I feel much better.
It has been suggested that the additional fiber content in the new formulation may inhibit the absorbtion of the thyroid hormones … possibly binding to the fiber and being swept from the body.
I have Medco and my doctor wrote a prescription for Nature-throid to Medco and Medco processed it. Make sure your doctor stands firm on it in case Medco comes back to the doctor…but they DID fill it and it’s on it’s way!
Karen
While typing my comment on this issue here, just now, Medco telephoned me! They insist that there is no desiccated thyroid medication available and that I would have to switch to a synthetic medication. I informed the caller that (1) they are wrong – dessicated thyroid medication is available, even if Armour isn’t, and (2) that Medco seems to be on its way to a new set of lawsuits regarding fraud in its attempts to switch patients to synthetic medications by misinforming patients and doctors. If such a lawsuit comes, Mary, PLEASE let us know so I can jump on that particular bandwagon.
I hope a ton of people read this post…Costco is a big club store that requires membership to shop there. You can use their pharmacy if you simply state to the door person that you wish to utilize pharmacy services and they will let you in. I only paid about 30 bucks cash (no insurance) for 90 days of armour thyroid. I feel Costco has the least amount of mark up on their drugs and have been completely satisfied with them. Hopefully many of you have a Costco nearby. Hope this helps!!
I got a call from MEDCO today saying the same as above-NO NATURAL THYROID For at least 3 months but most likely longer-they are sending my script back!!!! Had problems and realized after info here on this site-withdrew the Armour and supplements and started low dosage Armour and the pain returned within 2 doses. I had been possibly diagnosed with ulcer, GERD–scope showed damage. 5 days off work,one hospital stay and now no meds since July 1st. I called every chain pharmacy and 2 places that make formulas no luck,except I could get Armour. My doctor has some Naturethroid, but can not use my insurance card. Until these insurance providers and the big drug companies are put in check there will be big problems with any new Health Care! (We will probably ened up bailing out Forest and Medco here in the near future!) If it is sugar in the Armour and they are considering diabetics- they succeeded in damaging me and could have provided a diabetic formula on request. I ended up getting empty gel capsules and I am going to crush the Armour and put it in the capsules, and see what happens.
Hey Mary:
I just contacted Medco by email letting them know I was reporting them to the authorities about their reporting of a shortage of Armour Thyroid. I received an email from their customer service representative suggesting I call and talk to a pharmacist about this.
I wrote her back and said that this is well beyond the scope of one of their pharmacists and it is a national health care issue. I told her I’d continue with my action to report them to every authority that has anything to do with this as named in another article of yours.
So, there Medo – take that!!! Their form letter simply infuriated me and reminded me to follow through completely with this. I hope others will too.
Mary:
I received a call from Medco health today as I emailed them complaining telling them I am filing complaints with the appropriate agencies that you listed. I was unavailable by phone.
I then got an email from them which said to contact their pharmacist about this matter.
I wrote them back, gave them a link to your article and said there is nothing to discuss with their pharmacist in view of the letter from their Executive Director.
I now want to file complaints and wonder if you can give us more specific information on how to file a complaint. I’m afraid an email may fall through the cracks and this matter deserves disciplinary investigation. The great loophole of these administrative agencies is when you don’t follow their “procedures.”
Can you clarify how to file complaints for us? That would be so helpful to make an effective statement that we’re not taking this anymore.
Thanks.
@char, and others
I used Mary’s previous blog (I found the link here: http://thyroid.about.com/b/2009/08/11/medco-thyroid-drug-scandal.htm) and wrote to as many people as she asked, and sent copies to the only medco email addresses I found available on their site, their media and investor relations links. I got a couple of calls from “The President’s Office” and spoke to someone who told me that RLC is having a shortage. I did see that information here, but I must say that I did receive some Nature-throid a few days ago by contacting (more than a week ago) an overseas pharmacy. (Contact information for this pharmacy was left as a comment by another commentor on another of Mary’s entries; he explained that you could get a 90 day supply with no prescription). I am glad that Medco finally responded, but that means that others outside of the Medco corporation are probably taking notice. I recommend everyone follow that link and write to let the people Mary Shomon recommends know exactly how angry you are. (I suppose that it didn’t hurt that I referred to Medco’s past practice in my email, quoted this column, and expressed my willingness to consider joining a lawsuit in the future even as I asked for an investigation into Medco’s practices.) Good luck, all, and hang in there. Even with the new shortages in Nature-throid, know that you will get medications soon – and maybe even (finally) thru Medco. (BTW, I got a year’s supply – given my prescription dosage, and deciding to cut the tablets of Nature-throid I got in the mail – at far LESS than I would pay for 4 months of co-pay at my local pharmacy for Armour through Medco. (Unless Nature-throid and Armour were wildly different in price, this suggests I’ve been overcharged for the medications in the past, doesn’t it?)
I mailed in a new prescription to Medco last week, being totally unaware of these developments. Needless to say, today I got the call from Medco, insisting that there is no type of natural thyroid available and they are returning my prescription. The past two months I had filled it at my local compounding pharmacy and was trying to switch to mail order to save a few bucks. I sure hope the local pharmacy can still get it. I wanted to let everyone know that I checked out http://www.inhousepharmacy.com and they are now reporting “sorry – temporarily out of stock” for BOTH Armour thyroid and Nature-throid.
Some of the posters here way want to buy a textbook regarding medications before reccomending overseas pharmacies. Maybe it will just be an example of Darwin’s Theory?
By Karen:
“I ended up getting empty gel capsules and I am going to crush the Armour and put it in the capsules, and see what happens.”
Uh, yeah, that’s illegal. Not to mention extremely dangerous without precise measurig scales. Please have a little more concern for your health people!
I would just like to add:
1) Switching between Armour and Nature Throid would require an Rx because 1 grain of Armour=60mg dessicated thyroid while 1 grain of Nature Throid=65mg. They are not interchangeable.
2) L-thyroxine (pure T4) aka levothyroxine, Synthroid, etc. is the drug of choice in treating hypothyroidism in any medical textbook.
3) Dessicated thyroid which contains both T3 AND T4 can vary widely in the ratio of T3:T4 (as much as 2-5 parts T3 to 1 part T4) Because of this patient response varies widely. It is not an ideal drug and reminds me of the days of the 1800’s when pharmacists dispensed compounds that did more harm than good.
Let’s look at this rationally for a moment. It is not a conspiracy by the “gub’ ment.” T3 is much more potent than T4 which is why some of you may think Armour or Nature Throid works better than levothyroxine aka pure T4 (Synthroid) In reality you just needed to be more patient while the dose of levothyroxine was increased.
This difference of anywhere from 2-5 parts T3 to 1 part T4 is exactly why people complain that one type of dessicated thyroid works better than the other. There is NO standard.
On the other hand, all the generic forms of pure T4 are virtually identical to Synthroid.
KEY:
Dessicated thyroid is in Armour and Nature Throid and contains BOTH T3 and T4
Pure T4 is levothyroxine or L-thyroxine for short. Brand names are Levothroid, Synthroid, and Levoxyl.
Make your lives easier and take the time to find the right dose of L-thyroxine. The generic L-thyroxine is the same as brand name versions. Unlike the dessicated products. Levothyroxine is synthetic….just like most other medicines.
Insulin has been made by recombinant DNA methods for decades now…before that patients had to inject purified insulin from pigs and cattle…and their were many adverse events.
I don’t know about you but I would prefer synthetic, predictable doses of T4 vs. unpredictable doses of T3 and T4 taken from pigs.
Have I got news for you. I think its a mater of money and profit for medco.
they are paid $10.60
$5.60 by my rx plan and $5.00 by me
they pay postage to mail the drugs to me and then have to collect on the copay- ie mail me a bill,
MARY- heads up girl!
There is no profit in it for them, let the fight continue!!!!!!
As I read most of these comments, they actually validate that Medco, as well as many retail pharmacies, is not able to obtain Naturethroid. And, sure, absolutely, without a doubt it’s about the money. Medco is a company. Companies try to make money. Companies are supposed to do that, or they go out of business. Duh. The person that wrote to Snow and Klemperer stated that Medco suggested levothyroxine. Medco makes money dispensing generics. The doctor has the right to refuse. Simple.