Thyroid Organizations Take On Generic Levothyroxine

The question remains: Are these groups concerned that these dramatically reduced sales for Synthroid will translate into reduced financial support for their organizations -- organizations that rely heavily on funding from drug companies? Is Synthroid putting behind the scenes pressure on the groups that benefit from its financial support? How much of the argument is legitimately scientific, and how much of it is market-driven?

Another question...why does Synthroid continue to price itself so high, as compared to its competitors? As noted earlier, here are costs at Drugstore.com for a 3 month, 88 mcg supply of levothyroxine:

• Synthroid,$41.99
• Levoxyl, $23.97
• Generic, $23.63
• Levothroid, $23.05

Yet, a survey of Canadian mail order pharmacies shows that the price for a 90 pill supply of Synthroid, 88 mcg, is approximately $21 to $24 US. Some industry analysts have suggested that Canadian retail drug prices are more representative of a fair retail price for American drugs, suggesting that the high markup on Synthroid may be motivated by profit.

In the case of Synthroid, for example, a Congressional investigation found that the monthly retail cost to seniors was $27.05 -- which was 1,446 percent more than the $1.75 paid by favored group purchasers at the time of the investigation. The question that this raises, is, if Synthroid can afford to charge bulk purchasers only a few dollars a month and still remain profitable, what is the actual manufacturing cost to the company, and why is it necessary to charge consumers as much as $40 or more per month for Synthroid?

What Should You Do?

The main question for you, of course, is: What should you do?

• First, keep in mind that consistency is key. If you are taking the same brand name of levothyroxine on a regular basis, this issue really should not affect you.
• Check your prescriptions when you pick them up. You may not always know when your HMO, insurance company, or even pharmacy, will substitute a generic for a brand name. Don't assume that you're continuing to get a brand name levothyroxine without confirming it, each time you get your prescription refilled.
• If you do not want the pharmacy to switch you to a generic without discussing it with you, be sure that you have your doctor write "Dispense as Written" (DAW) or "No substitution" on your prescription slip. Note, however, that your HMO or insurer may only cover the cost of generic drugs, and refuse to reimburse you for brand name drugs.
• If your HMO or insurer refuses to cover a brand name levothyroxine, consider talking to the company's consumer representative or ombudsman to see if this can be negotiated, or have your doctor write a letter regarding your medical need for a brand name medication.
• Keep in mind that the copay for your medication, often $10 or $20 per prescription, may be close to the cost of medication. Rather than fight with your insurer, you may want to simply pay for a lower-cost brand name, like Levoxyl -- out of pocket.
• If you are pregnant, or have had thyroid cancer, talk to your physician, but you probably will not want to accept generic levothyroxine. Even if you have to pay out-of-pocket for your medication, consistent thyroid medication is essential. Regarding reimbursement, your doctor may be able to argue with your insurer or HMO that your health requires a brand name medication.
• If you want to switch from a more costly brand, i.e., Synthroid, to a lower-cost brand, plan to have your thyroid retested after about six to eight weeks, to make sure that the dosage of the new drug is correct for you.
• If you must stay on a generic, talk to your pharmacist. It may be possible to informally ask the pharmacist to get a particular generic brand. There are no guarantees, but a good relationship with the pharmacist can often go a long way.

And, in my opinion, don't forget to contact the various groups that represent thyroid patients and professionals, and tell them as a thyroid patient, you want your interests represented. Personally, I think it means wanting not only a policy that puts patients -- and not insurers and HMOs -- first when it comes to generic vs. brand name levothyroxine, but one that does not favor Synthroid or another drug. Especially when a brand is substantially more costly, without conferring any particular scientific benefit for that extra cost, as compared to its competitors.

Ultimately, the concerns of these groups -- and patients -- could be dramatically reduced if Synthroid brought its costs in line with its competitors, or if HMOs and insurers could specify that patients get the lower-cost brand name levothyroxine drugs, like Levoxl, Levothroid or Unithroid.

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