The People's Perspective on Medicine

Why Is This Pharmacist Complaining About Levothyroxine Shortages?

Why do pharmacy chains change generic manufacturers? A pharmacist blames drug shortages. Are levothyroxine shortages really to blame for a readers concerns?

Let’s get one thing straight. We are mad as hell about drug shortages. There is no question that important medicines have been in short supply for years and the FDA has done very little to help correct this tragic situation. All we get from the agency is an FDA Drug Shortages list that is updated regularly. It does not help resolve the problem. At last count, there are over 100 different medicines in short supply. Below you will read a complaint from a pharmacist about levothyroxine shortages. The trouble is, we haven’t detected any recent oral levothyroxine shortages.

Are Levothyroxine Shortages to Blame for Switching Manufacturers?

Q. I wanted to respond to your column about generic levothyroxine. The person writing to you had taken levothyroxine from three different manufacturers within six months. She worried that such switching might pose a problem.

I am a pharmacist. The reason patients have been getting levothyroxine from different manufacturers is due to shortages, particularly of Mylan medicines. Believe me, pharmacists want patients to stay on levothyroxine from the same company. However, when the product is unavailable, we have to switch manufacturers, or the patient gets nothing.

Why don’t you write about all the shortages of common drugs? The public needs to understand we pharmacists are on their side, but sometimes our hands are tied.

A. We share your sense of frustration about drug shortages. This crisis has been going on for years. Although the FDA publishes a list of medicines in short supply, it has not offered solutions to this supply-chain difficulty.

When drug makers have quality-control problems, they frequently recall substandard medicines. Such has been the case with blood pressure pills like losartan and valsartan. This is challenging for pharmacists, patients and physicians.

Yet Another Losartan Recall:

FiercePharma reports (April 22, 2019) that:

“India’s Torrent Pharmaceutical recalled 104 lots of losartan [and losartan plus hydrochlorothiazide] over the weekend because they contained an impurity suspected of causing cancer.”

This is just the latest in the never-ending recall of ARB blood pressure medicines that started last July. We have lost count of the number of lots of irbesartan, losartan and valsartan that have been pulled off the market.

In case you might think that 104 lots are not that many, think again. It represents more than one million bottles of blood pressure meds. If there were only 30 pills in a bottle, that would represent at least 30 million pills. But many of these bottles contain 90 pills and quite a few contain 1,000 pills. That means a huge number of losartan pills have just been recalled. That could mean shortages. Here is the FDA’s announcement from the company.

What About Levothyroxine Shortages?

The pharmacist who contacted us was responding to a comment from one of our readers. She had been switched from levothyroxine made by Mylan to levothyroxine from Lannett and then levothyroxine from Sandoz. This all took place in less than six months. This person was concerned about potential variations between generic formulations of levothyroxine.

We searched the FDA’s drug shortages list over the last six months. We could not find any mention of levothyroxine shortages, although there was a shortage about a year and a half ago.

We fear that many large chain pharmacies are always searching for the best deal they can get. Since the FDA reassures doctors, pharmacists and patients that all generic drugs are identical, price becomes a key factor in buying decisions.

While we cannot prove that the switching this person encountered with levothyroxine was driven by price, we could not link it to levothyroxine shortages either. We wish we could believe that all FDA-approved generic drugs were of the highest quality. But recent recalls challenge that viewpoint.

Should you wish to read about our investigation into the FDA’s generic drug approval process and our concerns about quality control, we recommend our book, Top Screwups. It is available at this link. You will learn how to protect yourself from generic drug problems. Sadly, there is no simple solution to the drug shortages disaster. 

Share your own thoughts about drug shortages. What has been your experience regarding being switched from one generic drug manufacturer to another by your local pharmacy? Please report your experience in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I just want to clarify something about recent shortages of levothyroxine. My insurance is Kaiser Permanente. I have levothyroxine prescribed for 3 months in each prescription, so I always have received 90 pills. For the last 8 months I have only received 30 pills each time and a letter from their pharmacy stating that there was a shortage of the medication because the manufacturer got affected by the latest hurricanes. Just this April they finally sent 90 pills again. So there has been a recent shortage, that is a fact. You probably couldn’t find anything about it because it just got “fixed”.

Here in Florida the Governor is urging the legislature to approve a request to the Feds to import drugs from Canada. The drug industry is responding with TV ads saying “stop dangerous drugs from China.” What a hoax–quality control from imports from China and India is almost non-existent, and Canada has a lot better control on their drug quality than the US fox-guarding-the-hen-house FDA. I understand little Vermont got this permission and is saving several million dollars on prescription costs.

I have taken levothyroxine since 1989. For years it was as Synthroid but when I reached 65 the then pharmacy benefit manager said I had to take generic. My first generic was a disaster producing nighttime anxiety attacks and insomnia. We were able to get my Synthroid back for medical reasons but I had to pay a premium price. Finally my primary said he would order Levoxyl. It’s a generic levothyroxine that he orders as Brand Necessary. It’s on record as medically indicated and Caremark doesn’t charge me a premium price. My TSH values are great and no other problems.

One generic gabapentin is like chalk. There is no coating – thus it’s cheap! It makes a mess and makes you think that if it’s rubbing off you can’t be getting the proper dosage of the medication. Luckily I finally found out I could request the brand I want. For a while I had to make sure I requested it early to give them time to special order it, but lately I have not had a problem. Thank goodness!

I would like The People’s Pharmacy to discuss costs associated with insurance vs. no insurance. Last month I was on deductible and paid the full amount for 2 prescriptions: $63. This month I had new insurance but had not received proof of insurance. The same prescriptions cost $563! Walgreens told me they keep it in the system for one week, so it could be reprocessed during that time frame. I did not get my proof of insurance in time. What do I do? Submitting it to the insurance company will only get about $63 (this insurance company’s negotiated rate) applied to my deductible. How do I get the rest of it back?

My cousin, who is a pharmacist and lives in a different state, told me that people without insurance always pay a higher rate, but I never imagined that the difference would be so much. Can you explain this? I’m sure I’m not the only one who would be interested in an explanation of how things work and how to navigate a situation like this.

I am surprised at this article for many reasons but one is this. It states that “pharmacists know to keep one mfr.” – I find that laughable. I have been taking levothyroxine for 20+ years and have moved just about as many times which means a new pharmacists each time. When I tell them why I want a particular mfr. and would like to stay with that mfr. when they refill my RX they are ‘surprised’ – they claim they never heard of that!!!!

I totally understand as I am hypothyroid. I ended up going to an independent compounding pharmacy because it was like playing Russian roulette with my health and wellbeing as the almighty dollar ruled at chain store pharmacies. Do not know what i am going to do when my pharmacist retires in a few more years.

Can you name foods that would be good for blood pressure? My husband has high blood pressure and finally agreed to take medicine for it, but it is so expensive that I think a special diet might be adequate instead of these over-priced drugs.

If you took the time to understand the real root cause of artificial drug shortages, you’d recognize that there is a simple solution: ending the “legalized” kickbacks/rebates paid by drug makers and other vendors to giant hospital group purchasing organizations (GPOs) and pharmacy benefit managers (PBMs). That could be accomplished via congressional repeal of the 1987 Medicare anti-kickback “safe harbor” statute, which exempted these cartels from criminal prosecution for taking kickbacks from drug makers and other suppliers. For a primer, read my Wall Street journal oped of 5/8/18, “Where Does the Law Against Kickbacks Not Apply? Your Hospital.” This article and extensive documentation appear on our website, The real problem is political. It’s not enough to express “frustration.” You could be a huge help in ending this global crisis by creating public awareness and outrage. Contact me through our website if you’d like to discuss further.

The entire drug situation in this country is outrageous and out of control.

If you are worried about the fillers, excipients and dyes in levo, use Tirosint, which is just pure levo. Of course, it’s more expensive, but worth it considering that one has to take this drug for one’s entire life.

I have stopped using Costco pharmacy because of their policy of going with the cheapest manufacturer. They will not allow me to request specific manufacturers in order to avoid the problematic ones. Their “commitment to saving me money” is worthless if the drugs are.

I had to get a generic prescription of fluconazole for my dog’s systemic yeast infection. The one Costco gave me was either counterfeit or plain useless. It was by Northstar. My dog had been on a different manufacturer previously, which took care of her symptoms. On Northstar, it was evident within two days that they didn’t work, as her symptoms returned full strength. I took it back to Costco to tell the pharmacy manager, as people take this, too, and may not realize their medicine isn’t working. The manager said there was nothing he could do. Costco doesn’t have a reporting system for such feedback, and that I should just call the manufacturer. Yet he was fully aware of the problem of ineffective generics.

Walgreen’s is only slightly better; I can ask for specific manufacturers and decline others. But this means I have to special order, with never any idea of how long it will take to get filled. Most of the time what they have to dispense is acceptable.

For the dog, I finally went to an independent pharmacy who could tell me which manufacturer they recommend, and paid more.

I, too, am upset and a little discouraged when my medicine has been changed to a different manufacturer. It’s happened not only with the Levothyroxine, but with Trazodone, Carvidilol, and Montelukast. I am gluten-free because of celiac, and every time they change to a different maker, I must check with the new manufacturers to see if there is any gluten in the excipients that make up the rest of the drug. Mostly I hear the main generic drug is gluten-free, but they can’t seem to tell me if the rest of the pill is GF. So basically, if I don’t get sick after a week’s trial, it’s GF; if I do have symptoms, it’s not. I have called the company back when I have had symptoms, and received an apology, and “are you sure it was the medicine and not the flu or something?”

Another irritation and confusing thing about switching brands is that the new one may be different in size or color. My new Carvidilol is so teeny I can barely see it at all. Sometimes I’ve had an old brand, and the new brand put in the same bottle with a note that said they switched manufacturers. I am 70 years old, and my eyesight is still good, but what happens as I get older and can’t watch out for myself?

I am sorry, but I think it’s all about profit and the bottom line. It’s not the pharmacists’ fault, but the company’s decision to switch to a cheaper alternative. Thank you for being a watchdog on the FDA and the pharmaceutical companies.

I would be very concerned about the changes that lady had. Many thyroid patients are very sensitive to various fillers, so when they find a manufacturer that worked for them they don’t like to be changed to one that may not agree with them.

I think drug stores are shopping for the best price! I had a prescription for a drug and researched which of the generic drug manufacturers had the best quality rating. I contacted 5 drug stores in my immediate area, and when I discussed which generic brand they had in stock 4 of them told me that the company changes monthly/quarterly based on price!!

I was so disappointed to learn that none of them cared about quality ratings….it was all about the price.

A few years ago, when I questioned why I had received three different generic brands of one of my meds in the course of several refills, the pharmacist told me flat out that it was all based on the best price available. Pharmacy benefits programs are now run through a few mega-management companies. How much do they influence the choices of generics available to the retail chains?

My big chain pharmacy changes manufacturers of my generic drugs all the time – levothyroxine, levothironine, amlodipine. Currently I have been waiting almost a month for Restasis refill which they say is due to shortage. They told me they called the distributor and other local stores, and all were out. This is unacceptable.

Once you say that Mylan is one of the drug companies involved in the “shortage”, you automatically know it’s a lie. Just an attempt on their part to dramatically increase the price of levothyroxine, as was done with the epi-pen. I was wondering how long it would be before they realized low/no thyroid patients were a huge, captive market that must take levothyroxine DAILY and FOR LIFE. Just wait and see its price skyrocket! What an irresistible cash cow for them to milk, and they don’t care if they bankrupt people in the process. Pay or die!

When Armour thyroid became unavailable, I researched and found naturethroid and the Dr. agreed to my switching to it. My pharmacy did not carry it but did request it for me, and that has worked. Fortunately I had a little stockpile to tide me over when naturethroid became unavailable, and I watched the website and notified the pharmacy when it became available. They immediately requested it for me and again all is well.

I buy my synthroid through a Canadian pharmacy. It is 1/3 the price, and there is never a shortage.

Although I can’t answer for the last 2 years when I was switched from Levothyroxine to Armour and then a few more different ones, I can attest that there has been a shortage of Naturethroid and WP Thyroid. I was never able to try WP because of the shortage, and last month Naturethroid was very difficult to find. I was on NP Thyroid as well but once again that, too, changed manufacturers. My pharmacist told me that they were NOT carrying that brand any longer, and it was definitely due to the price!

I was also told that many pharmacies were no longer going to give Cipro out for free as they were doing, and I was thrilled because at first I heard it was due to all the FDA warnings that came out about ALL the Fluoroquinolone antibiotics but then I found out the truth! Their bottom line was going to be affected, and therefore it was not for any altruistic reason. It was due to the almighty dollar!

Sadly, it always is.

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