Reimbursement for Lithium carbonate 400mg modified release tablets prescriptions

Reimbursement for Lithium carbonate 400mg modified release tablets prescriptions

September 4, 2020

On 21st August 2020, the Department of Health and Social Care (DHSC) issued a supply disruption alert stating that Priadel®(Lithium carbonate) 200mg and 400mg modified-release tablets are being discontinued in the UK and remaining supplies of both strengths are expected to be exhausted by April 2021. The supply disruption alert details alternative licensed lithium brands which are available; Camcolit® is another brand of Lithium 400mg modified release tablets but there is no alternative brand available for Lithium 200mg modified release tablets. The full alert can be viewed here.

Prescriptions for lithium prescribed by brand name are reimbursed based on the brand list price held on dictionary of medicines and devices (dm+d). However, where a prescription is written generically ordering Lithium carbonate 400mg modified release tablets x 100, pharmacy contractors would only be reimbursed as per the Drug Tariff Part VIIIA price which is currently based on the reference product Priadel with a list price of £4.02 (based on September 2020 Drug Tariff).

Where pharmacy teams receive a generically written prescription for Lithium carbonate 400mg modified release tablets and the Camcolit brand is required for the patient, pharmacy teams are advised to refer the prescription back to the prescriber to be written for the brand.  If the Camcolit brand is dispensed against generically written prescriptions for Lithium carbonate 400mg modified release tablets, pharmacy contractors would only be reimbursed the Part VIIIA Drug Tariff price of £4.02 (based on September 2020 Drug Tariff) instead of the Camcolit brand dm+d list price of £48.18 for a pack of 100 tablets.

Due to the narrow therapeutic index of lithium and the variation in bioavailability between different lithium preparations, pharmacy teams should expect prescriptions to specify the brand of lithium required. Patients must be maintained on the same brand of lithium to ensure that a consistent serum lithium level is maintained. Changing the preparation requires the same precautions as initiation of treatment and any decision to switch brand must be made by a specialist. Please note: Priadel 520mg/5ml liquid is not being discontinued but this contains lithium citrate and not lithium carbonate. If prescribers deem a switch to a liquid formulation appropriate, relevant guidance should be consulted to ensure safe switching.



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