Individual Funding Requests are not intended to be used for rationing treatments, such as liothyronine. All clinical commissioning groups have their own Individual Funding Request policies that enable commissioners to focus on commissioning services that will meet the majority of their local population’s needs without spending funds on services that very few people may need access to.

The Department has not held any discussions with integrated care boards regarding their policies on liothyronine. NHS England regional teams have distributed the Items that should not be prescribed in primary care policy guidance to local healthcare systems. These systems are responsible for ensuring that prescribing practices follow the guidance provided.

The Department has not held any discussions with integrated care boards regarding their policies on liothyronine. NHS England regional teams have distributed the Items that should not be prescribed in primary care policy guidance to local healthcare systems. These systems are responsible for ensuring that prescribing practices follow the guidance provided.

NHS England’s policy guidance and prescribing advice on liothyronine reflects the National Institute for Health and Care Excellence’s recommendations and the evidence on liothyronine. That guidance recommends that liothyronine should not be routinely prescribed, because it is not clinically or cost-effective, but sets out the exceptions where it may be an appropriate consideration for prescribers.

NHS England expects commissioners and prescribers to have due regard to its guidance. While integrated care boards may determine their own implementation arrangements, as part of the new operating model, regions will oversee commissioner and provider performance, including access to high quality care and the reduction of health inequalities.

NHS England’s policy guidance and prescribing advice on liothyronine reflects the National Institute for Health and Care Excellence’s recommendations and the evidence on liothyronine. That guidance recommends that liothyronine should not be routinely prescribed, because it is not clinically or cost-effective, but sets out the exceptions where it may be an appropriate consideration for prescribers.

NHS England expects commissioners and prescribers to have due regard to its guidance. While integrated care boards may determine their own implementation arrangements, as part of the new operating model, regions will oversee commissioner and provider performance, including access to high quality care and the reduction of health inequalities.

Decisions about prescribing liothyronine are made by the responsible clinician. NHS England guidance, which aligns with National Institute for Health and Care Excellence guidance on the assessment and management of thyroid disease, is clear that liothyronine should not be routinely prescribed in primary care. Where clinically appropriate, liothyronine should only be initiated by a National Health Service consultant endocrinologist, and only where no clinically appropriate alternative treatment is available.

Integrated care boards are responsible for local commissioning arrangements and for supporting the application of national guidance, but it is for clinicians, working with their patients, to decide on the most appropriate treatment in line with that guidance.

There has been no assessment made of the Competition and Markets Authority’s findings, but no company should exploit the National Health Service. Anti-competitive behaviour, including excessive pricing, is a matter for the Competition and Markets Authority.

There have been no discussions with the manufacturers of Liothyronine regarding the cost of the product because the Government’s policy on generic medicines is to allow suppliers freedom of pricing for their products, relying on competition between suppliers and efficient purchasing by community pharmacies to deliver value for money for the NHS. This also means that companies can increase their prices when supply is low, or demand is high.

Several marketing authorisations for different suppliers have been granted for generic liothyronine since 2016, the NHS reimbursement price in primary care has reduced, and the price remains firmly below its peak from 2018.

Integrated care boards (ICBs) are responsible for supporting appropriate prescribing in their areas, taking account of this guidance and individual clinical circumstances.

National Health Service regions cascaded the Items which should not be routinely prescribed in primary care policy guidance, which includes a reference to liothyronine, to ICBs.

The Department has no current plans to meet representatives of Thyroid UK and The Thyroid Trust to discuss the prescribing of liothyronine in primary care.

The inclusion of liothyronine in the guidance will be reviewed only if there is a significant change in the evidence, including National Institute for Health and Care Excellence (NICE) guidance on the assessment and management of thyroid disease, which currently aligns with the policy guidance recommendations.

No assessment of integrated care boards’ adherence to guidance has been made. Regions cascaded the ‘items that should not be prescribed in primary care’ policy guidance to systems who are responsible for ensuring prescribing is in line with the available guidance.

The Department and NHS England do not collect or hold this data, as integrated care boards make exceptional funding requests for liothyronine, and therefore the information would be held by individual integrated care boards.

The inclusion of liothyronine in the guidance will be reviewed only if there is a significant change in the evidence, including National Institute for Health and Care Excellence (NICE) guidance on the assessment and management of thyroid disease, which currently aligns with the policy guidance recommendations.

No assessment of integrated care boards’ adherence to guidance has been made. Regions cascaded the ‘items that should not be prescribed in primary care’ policy guidance to systems who are responsible for ensuring prescribing is in line with the available guidance.

The Department and NHS England do not collect or hold this data, as integrated care boards make exceptional funding requests for liothyronine, and therefore the information would be held by individual integrated care boards.

The inclusion of liothyronine in the guidance will be reviewed only if there is a significant change in the evidence, including National Institute for Health and Care Excellence (NICE) guidance on the assessment and management of thyroid disease, which currently aligns with the policy guidance recommendations.

No assessment of integrated care boards’ adherence to guidance has been made. Regions cascaded the ‘items that should not be prescribed in primary care’ policy guidance to systems who are responsible for ensuring prescribing is in line with the available guidance.

The Department and NHS England do not collect or hold this data, as integrated care boards make exceptional funding requests for liothyronine, and therefore the information would be held by individual integrated care boards.

Regional chief pharmacists have been informed of the changes made to the liothyronine section, including Armour Thyroid and liothyronine combination products, of the ‘items that should not be prescribed in primary care’ policy guidance via email. They have been asked to cascade this information through their integrated care board’s regional networks.

The National Institute for Health and Care Excellence (NICE) has not made any recommendations on the use of liothyronine in the treatment of thyroid cancer. NICE published a guideline on the assessment and management of thyroid cancer in December 2022. There are currently no plans to review the guideline.

NHS England produced advice for prescribers on the use of liothyronine, otherwise known as T3, in August 2023 that sets out details on those patients that may benefit from T3 and how prescribers can prescribe this medicine to those patients. It recommends liothyronine as part of the management of thyroid cancer in preparation for radioiodine remnant ablation and radioiodine therapy. The advice is available at the following link:

https://www.england.nhs.uk/long-read/liothyronine-advice-for-prescribers/

We are aware that liothyronine 20 microgram vials will be out of stock from October 2025 until the end of April 2026. NHS England will be issuing national communications containing advice during the period of disruption to supply of the licensed product, outlining the availability of unlicensed imports and other clinical alternatives. NHS England is not aware of any supply issues affecting oral presentations of liothyronine.

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.

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.

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.

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.

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.

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.

The current Gloucestershire Integrated Care Board guidance on the prescribing of liothyronine was agreed by the former Gloucestershire Clinical Commissioning Group in April 2023. Any patients new to Gloucestershire will have their current clinical status reviewed within the existing local clinical pathway. This process will involve an initial ‘advice and guidance’ specialist review which, based on individual patient circumstances, will inform a decision on whether a more detailed specialist clinical review is indicated or not.

The intention is that ongoing treatment of a patient’s condition will normally continue whilst the clinical review process is completed. The outcome of this process is that local specialists, general practitioners, and patients can have a high level of confidence in the quality and standards of care provided to patients indicated for liothyronine on the National Health Service in Gloucestershire.

No assessments have been made.

The Department has no plans for a review. The current Gloucestershire Integrated Care Board guidance on the prescribing of liothyronine, agreed by the former Gloucestershire Clinical Commissioning Group in April 2022, is under a local review to be completed within the next four months and will consider the position on new patients already on liothyronine moving into Gloucestershire.

No specific assessments have been made of the costs of reviewing patients currently prescribed liothyronine in secondary care.