Availability of thyroid medications impacts thyroid patients, especially those who take 'non-conventional' medications such as NP thyroid.
Recently, I've been getting reports from some patients who have not been able to get NP thyroid from specific pharmacies, namely CVS.
A recent recall of both levothyroxine and liothyronine by Westminster pharmaceuticals on August 10, 2018 has lead to an increase in demand for NDT (all formulations).
This demand was being met by NP thyroid, but now it seems that NP thyroid may be getting more difficult to get based on some recent changes from CVS pharmacy headquarters.
CVS & NP Thyroid
Due to these reports and difficulty that some patients are experiencing in acquiring NP thyroid, I spent some time calling local CVS pharmacies and talking to pharmacists to figure out what is happening and here is what I found:
CVS, as a pharmaceutical company, does not want to carry or fill NP thyroid.
Prior to this new change, it was already difficult to get NP thyroid stocked in each store.
This process required a call directly from the pharmacist to headquarters to get approval.
CVS headquarters wanted to ensure that pharmacists would first try to get approval from the doctor to switch to other medications or to try another alternative such as levothyroxine (which is obviously less than ideal for those taking NP thyroid).
It sounds as if this process was made more difficult on CVS's end to encourage the use of other medications.
More recently, and this is perhaps why some patients are having more difficulty nowadays, CVS has made some changes in regards to whether or not they will stock NP thyroid.
According to the NP thyroid.com website, they have stated that the CVS pharmacies will no longer stock NP thyroid.
These new changes from CVS headquarters are what is causing the difficulty that patients have been experiencing.
The new changes (within the last few months), on the side of CVS, have made it more difficult for pharmacists to order NP thyroid.
Having said that, some CVS pharmacists have assured me that they are still able to order NP thyroid despite the fact that it will not be stocked in their pharmacies.
To get NP thyroid from a CVS pharmacy you must do the following:
- Call your local CVS store and specifically request that the pharmacist places an order for NP thyroid.
If you do this you should then be able to get your prescription filled.
According to the pharmacists that I've talked to about this topic, CVS headquarters would like all patients on NP thyroid to be switched to either Armour Thyroid or, preferably, levothyroxine/Synthroid.
Please be aware, however, that this will require an extra step from the pharmacist at your CVS office.
They may (or may not) be willing to take this extra step.
If this happens to you then there are some other options that I discuss below.
How to get NP Thyroid
What should you do as a patient if it's difficult to get your medication?
Well, you have a couple of options:
#1. Transfer your prescription to another pharmacy.
The easiest thing to do may be to simply request that you transfer over your prescriptions to another pharmacy.
You can do this by calling the pharmacy and giving them a name and location of another pharmacy.
Pharmacies don't like doing this, but it does send the message to them that if they aren't willing to stock your medication that you will move somewhere else.
You can fairly easily transfer all of your existing prescriptions to another pharmacy with a phone call.
#2. Call your CVS pharmacist and ask to see if they can fulfill your order and keep a stock of medication on hand.
If CVS is the only local pharmacy (or just the best price) then you can still try asking the pharmacist of your local CVS if they are willing to order each month for you.
This is not the best option, however, and it makes me nervous because with this strategy it doesn't allow for much wiggle room.
For instance, what happens if your pharmacy forgets to fill your prescription one month?
If that occurs, and this stuff does happen from time to time, you may have no other way to get your medication or you must be switched to another alternative.
In this sort of situation, the pharmacy would definitely work with you to get you some type of medication, but it may not be what you are used to.
As a thyroid patient, you probably know that once you find what works for you, you really don't want to deviate from that medication/dose unless absolutely necessary.
This is why I recommend that thyroid patients try to build up a 1 year supply of thyroid medication just to be safe.
#3. Switch to another NDT alternative.
This is probably the least attractive option but it may be your only option depending on your scenario.
Switching to another formulation of NDT seems like something that should be relatively easy but that isn't always the case.
Each formulation of NDT differs in the inactive ingredients that it contains and these inactive ingredients can have a mild to profound effect on how you tolerate the medication.
The good news is that all of the NDT formulations contain the same amount of T4 and T3 grain for grain which can make dosing relatively easy.
The bad news is that, upon switching, you may notice a slight difference in how your body reacts to or tolerates the new medication.
Some people, when switching NDT formulations, notice a resurgence in their hypothyroid symptoms or other mild symptoms such as stomach upset, headaches, or rashes.
A resurgence in your hypothyroid symptoms is probably an indication that your new formulation is impacting your ability to absorb your new medication.
Whereas other more mild symptoms such as headaches or rashes probably indicate that you are reacting negatively to the inactive ingredients.
It's also possible, and hopefully, this is the case for most of you, that the switch will not result in any negative side effects or consequences and you will feel just the same afterward.
How you react will depend on too many factors to list here, but just realize that this may happen.
One potentially big downside of switching to a different formulation of NDT is the price.
NP thyroid is probably the most competitively priced NDT formulation on the market.
According to goodrx.com, a month worth of 1 grain of NP thyroid will cost you between $7.00 and $13.00 per month.
This is in contrast to other formulations like Armour thyroid which run about $28.00 to $35.00 per month.
The difference between $7.00 and $28.00 may not be a lot for some people but it may be a big deal for others.
It's just another thing you really don't want to have to worry about.
#4. Switch to a T4/T3 combination which approximates your current dose.
Lastly, if all other options fail, then you do have the ability to try and switch to a combination of T4 and T3 medication.
You can do this by calculating how much T4 and T3 you are taking in your current dose and then attempting to approximate that dose with individual prescriptions for T4 and T3.
It's not a perfect strategy, but it's one you should be aware of, especially if you don't tolerate other formulations of NDT.
As an example:
Imagine you are taking 1.5 grains of NP thyroid and now you are no longer able to get it.
How much T4 and T3 is in your dose?
Each grain of NP thyroid contains 38mcg of T4 and 9mcg of T3.
So 1.5 grains of NP thyroid contains 57mcg of T4 and 13.5mcg of T3.
Once you have this information you could ask your doctor to write a compounded thyroid prescription which contains exactly that amount of T4 and T3.
Note: you will need to go to a compounding pharmacy in order to get a prescription like this filled.
So, to recap, does this mean that NP thyroid is no longer available for thyroid patients at CVS?
It may seem that way but the answer is no.
But it does mean that it's a little bit harder to get.
As a thyroid patient taking NP thyroid you will need to call directly into your local pharmacy and make a request that your pharmacist order NP thyroid on your behalf.
Most pharmacists should be accommodating to this request!
There is a difference between stocking a medication and ordering it as necessary.
Some pharmacies do not keep all medications stocked at all times due to the fact that some medications are used less frequently than others.
But these medications can still be ordered by the pharmacist and a small stock can be maintained.
It looks like CVS no longer keeps a steady stock of NP thyroid but individual CVS pharmacies can still order it on demand.
The availability of NP thyroid from your local pharmacy will likely depend on how receptive your pharmacist is to ordering extra just for you (or a few others).
If all else fails, you still have other options that you can explore (listed above).
Now I want to hear from you:
Have you been having trouble getting your NP thyroid prescription filled?
Have you run into any trouble with CVS?
Have you been able to talk to the pharmacist to see if they would be willing to order NP thyroid specifically for you?
What has been your experience?
Leave your questions or comments below!